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NAVMED P-5088 




Vol. 45 



Friday, 30 April 1965 



No. 8 



r , 




CONTENTS 



FEATURE ARTICLE 

"What's New in the Management of Trauma" — TheUse 
of Sodium Bicarbonate and THAM in Injured Pa- 
tients 1 

MEDICAL ARTICLE 

Reproducibility of the Technic of Mammography 
(Egan) for Cancer of the Breast 2 

FROM THE NOTE BOOK 

Drug Warning 9 

Oral Surgery Lecture at U.S. Naval Hospital, San 

Diego 9 

Letter of Appreciation 10 

Naval Intern Matching Success . . — 10 

Suggested Format for Command Professional Relation- 
ship with Representatives of Pharmaceutical Manu- 
facturers 10 

Naval Medical Research Reports 12 

DENTAL SECTION 

Oral Hygiene of the Interdental Area 14 

Factors Influencing Centric Relation Records in Eden- 
tulous Mouths 14 



Zirconium Silicate for Use as a Cleaning and Polishing 

Agent for Oral Hard Tissues 15 

Some Precautions to Observe in Application of Three- 
Agent Stannous Fluoride Treatment 15 

Dental Health Education Material 16 

Know Your Dental Corps (Part II) 16 

Personnel and Professional Notes 17 

AVIATION MEDICINE 

New Developments in Naval Aviation Sea Survival 

Equipment 20 

Flight Physiology Notes 24 

Flll-B (TFX) Escape and Survival System 26 

MISCELLANY 

LCDR Tober Named First Recipient of APhA Military 

Section Literary Award 27 

Cautions Regarding the Use of Potassium Chloride __ 28 

Isometric Exercises for the Upper-Extremity Stump __ 28 

A Study of Alcoholics 29 

American Board of OB-GYN 29 



Vol. 45 



United States Navy 

MEDICAL NEWS LETTER 

Friday, 30 April 1965 

Rear Admiral Robert B. Brown MC USN 
Surgeon General 

Rear Admiral R. 0. Canada MC USN 
Deputy Surgeon General 

Captain F. R. Petiprin MSC USN, Editor 

William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine Captain J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine Captain J. H. Schulte MC USN 



No. 8 



Policy 
The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: The United States Naval Hospital Chelsea, Massachusetts is the oldest Naval Hospital 
in continuous service having been commissioned in 1836. 

In 1823 the land (115 acres) was purchased from Dr. Waron Dexter of Boston for $18,000. It was 
part of a community known as "Winnisimmet" the first permanent settlement in Boston Harbor, established 
in 1624-25. 

During the Battle of Bunker Hill, 17 June 1775 women and children gathered on the site, with its 112 
foot elevation to watch the battle. 

The present main building was constructed in 1915 just in time for the hospital to cope with the influ- 
enza epidemic of 1918. In World War II admissions rose from 279 in 1939 to 2700 in 1943. Among the 
patients was a Lieutenant John F. Kennedy, USNR, our late President of the United States, who was sent 
there for treatment for wounds suffered when his PT Boat was cut in half in Pacific Combat. 

Chelsea Naval Hospital is a completely modern teaching hospital working in close concert with many 
outstanding hospitals in the Boston area. A number of Boston's leading specialists serve as consultants to 
insure that hospitalized personnel have the finest medical care available. 

This hospital has played a pioneer's role in the development of frozen blood, whereby blood can be stored 
indefinitely and re-introduced to prospective recipients. 

Workload data of the hospital for F.Y. 1964 was as follows: outpatient visits 108,189; admissions 
7,322; discharges 7,361; immunizations 7,719; pharmacy transactions 121,511; operations 1,175 and de- 
liveries 1,033. — Editor 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



FEATURE ARTICLE 



"WHAT'S NEW IN THE TREATMENT OF THE INJURED" 
THE USE OF SODIUM BICARBONATE AND THAM EST INJURED PATIENTS 

Frank C. Spencer, M.D. 



The Frequency of Metabolic Acidosis in 
Traumatic Shock 

Any injury which impairs the transport of oxygen 
to tissues of the body quickly results in metabolic 
acidosis. This occurs because of the rapid develop- 
ment of anaerobic oxidation. Normally cells utilize 
oxygen as aerobic oxygenation in which the princi- 
pal end-products are carbon dioxide and water. 
When an adequate amount of oxygen is not avail- 
able, anaerobic oxidation (oxidation in the absence 
of oxygen) develops in which the principal end- 
products of metaloblism are lactic and pyruvic acids. 
The accumulation of these acids results in metabolic 
acidosis. 

It is important to realize that any type of serious 
injury which impairs respiration or circulation will 
result in metabolic acidosis. The causes are numer- 
ous. Pulmonary causes include airway obstruction, 
pulmonary disease, pulmonary trauma, crushing in- 
juries of the chest, or any disorder which impairs 
ventilation. Circulatory factors include hypotension 
from the loss of blood, fluid depletion, septic shock, 
myocardial injury, or any other condition causing 
hypotension. In many injured patients more than 
one of these factors are present. 

Normally the buffer systems of the blood main- 
tain the pH of venous blood in a narrow range of 
approximately 7.35 to 7.45. Mild degrees of acidosis 
are readily compensated for by the buffer systems; so 
a significant decrease in pH indicates the accumula- 
tion of a large amount of abnormal metabolic acids. 
As long as the pH of the venous blood remains 
above 7.30, few harmful physiologic affects occur. 
A venous blood pH in the range of 7.20-7.30, even 
though few clinical signs are evident, is definitely 
abnormal and should always be treated. 

When metabolic acidosis is severe enough to de- 
press the pH of mixed venous blood flow below 
7.20, many serious physiologic disturbances rapidly 
occur. Respirations, which initially are stimulated 



by the acidosis in a reflex attempt to expel carbon 
dioxide and lower the carbon dioxide tension 
(thereby compensating for the metabolic acidosis by 
producing hypocapnia), will become depressed. At 
lower levels of pH there is complete cessation of 
respiratory function. A frequent mode of death in 
such patients who initially were hyperventilating is 
sudden cessation of all respiratory activity, appar- 
ently from central depression of the respiratory 
center. 

Hypotension also occurs with severe acidosis 
partly because catecholamines are less effective in 
the presence of acidosis, including both epinephrine 
and norepinephrine. Consciousness is gradually im- 
paired, as the patient becomes increasingly drowsy. 
The familiar picture of diabetic coma is a classic 
example of depression of consciousness from meta- 
bolic acidosis. With severe acidosis renal function 
is also depressed. Finally, cardiac function is im- 
paired from metabolic acidosis, resulting in further 
impairment of blood flow to the anoxic tissues. 
These cumulative effects are superimposed upon the 
initial injury, resulting in a rapid intensification of 
the metabolic acidosis with a fatal outcome unless 
treatment is quickly employed. 

The Use of Sodium Bicarbonate 

Sodium bicarbonate is usually available in 50 ml. 
sterile ampules, containing 3.75 gms. of sodium bi- 
carbonate or approximately 45 milli-equivalents. 
Sodium bicarbonate cannot be prepared by custom- 
ary techniques of heating because sodium carbonate 
will be formed. With severe acidosis, two ampules 
of sodium bicarbonate (7.50 gms, or 90 meq.) 
should be given intravenously within 3 to 5 minutes. 
This should be given directly without dilution, as 
there is virtually no risk from the rapid infusion of 
sodium bicarbonate. A good guide to the severity of 
acidosis if pH determinations are not available is the 
state of consciousness of the patient. In a seriously 
ill hypotensive, comatose patient, the empiric admin- 



U.S. NAVY MEDICAL NEWS LETTER 



1 



istration of 90 meq. of sodium bicarbonate is a valu- 
able immediate form of therapy. Subsequent therapy 
can be rationally employed only if blood pH deter- 
minations can be done. With persistent acidosis, 
large amounts of bicarbonate may be required as 
acidosis recurs. Ten, twenty, or even thirty grams 
of bicarbonate may be required over a period of 
hours if the primary difficulty cannot be corrected. 
The realization that large amounts may be needed is 
an important concept, because therapeutic efforts 
are futile in the presence of a severe acidosis, which 
in turn profoundly depresses many vital cellular 
functions, including respiration, cardiac action, renal 
function, and vasomotor tone. 

Blood pH samples should be taken from a central 
vein, preferably through a catheter in the superior 
or inferior vena cava. Lacking the presence of an 
indwelling catheter, samples can be obtained by di- 
rect puncture from a femoral vein. Venous samples 
from an extremity, where stasis may be present, may 
be misleading. The pH of the mixed venous blood 
is more significant than the pH of arterial blood, 
because arterial blood pH is influenced by the ade- 
quacy of respiration. The venous pH, representing 
the changes in the blood after perfusing the cells 
of the body, is a much more accurate index of the 
severity of metabolic acidosis. 

The Use of THAM (Tris Hydroxymethyl) 
Amino-methane 

This agent, though still classified as an investiga- 
tional drug, has been widely studied in the past five 
years in the treatment of acidosis. It has the advan- 
tage of being a highly effective agent for neutraliza- 



tion of acids in vivo and is free of sodium. This 
point, however, is probably of significance only in 
the treatment of patients with cardiac failure. Ex- 
cept for avoiding the infusion of large amounts of 
sodium, there is no good evidence that THAM is of 
any greater value in the treatment of acidosis than 
the infusion of sodium bicarbonate. THAM has ad- 
ditional metabolic effects, the most prominent being 
the induction of an active osmotic diuresis. 

THAM is customarily infused in a .3 molar solu- 
tion, (36 gm./liter), which is isotonic with blood. 
An average dose of THAM is 150 mg./kg. body 
weight. This is approximately 10.5 gm. of THAM 
or about 85 meq., which produces about the same 
acid neutralizing effect as two ampules of sodium bi- 
carbonate. Much larger amounts of THAM are well 
tolerated, infusing as much as one gm./kilo. of body 
weight when necessary. An excellent recent publica- 
tion of the use of THAM in large amounts is by 
Nahas, G. G., et al (Control of Acidosis and the Use 
of Titrated ACD blood in Open Heart Surgery. 
Annals of Surgery 160, 1049, 1964). 

In summary, metabolic acidosis invariably occurs 
with severe trauma as a result of impaired transport 
of oxygen to the tissues. Multiple causes may be 
present, including impairment of ventilation, cardiac 
function, and hypovolemia. The prompt infusion of 
90 meq. of sodium bicarbonate (two 50 ml. am- 
pules) is a valuable initial mode of therapy in des- 
perately ill patients, especially if pH determinations 
are not readily available. Further therapy is best 
guided by serial determinations of the pH of central 
venous blood. pH determinations are no more com- 
plex than measuring an hematocrit and deserve much 
wider utilization in resuscitation of injured patients. 



REPRODUCIBILITY OF THE TECHNIC OF MAMMOGRAPHY (EGAN) FOR 

CANCER OF THE BREAST 

R. Lee Clark, MD* Murray M. Copeland, MD* Robert L. Egan, MD,** H. 
Stephen Gallager, MD* Harvey Geller,^p John Paul Lindsay, MD,& Lewis C. 
Robbins, MD, # and E. C. White, MD* 



Mammography shows promise of being an impor- 
tant diagnostic aid in control of cancer of the breast. 

* From the Departments of Surgery and Pathology, The University 
of Texas, M. D. Anderson Hospital and Tumor Institute, Houston, 
Texas. 

**From the Department of Radiology, Methodist Hospital, Indian- 
apolis, Indiana. 

#From the Cancer Control Program, Division of Chronic Diseases, 
Public Health Service, Washington, D.C. 

& General practitioner, Atlanta, Georgia. 



Lack of knowledge of what the technic offers tends 
to impede continued development and professional 
acceptance of mammography. For this reason the 
Public Health Service has collaborated with The 
University of Texas, M. D. Anderson Hospital and 
Tumor Institute, in cooperation with twenty-four 



U.S. NAVY MEDICAL NEWS LETTER 



other medical institutions,// to evaluate the repro- 
ducibility of a recently reported mammographic 
technic by radiologists previously unfamiliar with its 
use. The results of this study are presented here to 
provide objective evidence on which to make judg- 
ments of the place of mammography in the diagnosis 
of cancer of the breast. 

S/LUTHER L. TERRY 

The twenty-year plateau in the death rate from 
breast cancer has persisted despite all efforts to re- 
duce it. Surgery and radiation, with present diag- 
nostic methods, seem to have reached their upper 
limits of salvage. Chemotherapy and hormones, 
while offering promise, do not present an immediate 
hope of greatly improving survival. As a result, 
every avenue is being explored in diagnostic and 
therapeutic research to increase the survival rate of 
patients with breast cancer. Mammography, as re- 
ported in recent literature, appears to offer potential 
as a diagnostic aid in identifying cancer of the breast 
in its early stages, and may detect occult lesions that 
cannot be detected by other means. This paper is 
basically concerned with the degree to which one 
promising technic of mammography can be repro- 
duced by radiologists not previously familiar with its 
use. 

Mammography is the roentgenographic examina- 
tion of the breast. In its present usage, no contrast 
medium which could obscure the pathologic condi- 
tion is injected into the ducts. Mammography pro- 
vides an objective graphic representation of the soft 
tissue of the breast and its pathologic state. 

The first use of mammography in the study of the 
breast for cancer was the work of Salomon 1 , in 1913, 
on gross pathologic specimens. Warren 2 , in 1930, 
reported the first clinical use of mammography. 
Prior to the last decade, Leborgne 3 , Gros*, Lane and 
Pendergrass 5 , Lockwood 6 and others continued ac- 
tive in the investigation of this technic, even though 
it was in general disuse as a clinical aid. 

During the early 1950's, interest in mammography 

//Austin Radiological Group, Austin, Texas; Baptist Hospital of 
Southeast Texas, Beaumont, Texas; Baptist Memorial Hospital, 
Houston, Texas; Baylor University Medical Center, Dallas, Texas; 
Bexar County Hospital District, San Antonio, Texas; Emory Uni- 
versity Hospital, Atlanta, Georgia; Evanston Hospital Association, 
Evanston, Illinois; Georgetown University Hospital, Washington, 
D.C.; Massachusetts General Hospital, Boston, Massachusetts; 
Memorial Center for Cancer and Allied Diseases, New York, New 
York; St. Vincent's Hospital, Jacksonville, Florida; Shannon West 
Texas Memorial Hospital, San Angela, Texas; Spohn Hospital, 
Corpus Christi, Texas; The Mason Clinic, Seattle, Washington; 
Tom Bond Radiological Group, Fort Worth, Texas; Tulane Uni- 
versity School of Medicine, New Orleans, Louisiana; University of 
California Medical Center, San Francisco, California; University 
of California School of Medicine, Los Angeles, California; Uni- 
versity of Illinois, Chicago, Illinois; University of Minnesota 
Medical School, Minneapolis, Minnesota; University of Texas 
Medical Branch, Galveston, Texas; University of Texas Southwest- 
ern Medical School, Dallas, Texas; University of Utah College of 
Medicine, Salt Lake City, Woman's Hospital, Detroit, Michigan. 



was restimulated by the work of Gershon-Cohen et 
al. r . In addition to demonstrating palpable tumors 
on the roentgenograms, he was able to delineate 
lesions that were asymptomatic which suggested the 
possibility of obtaining an earlier diagnosis of breast 
cancer. 

In December 1960, Egan 8 , then of The University 
of Texas M. D. Anderson Hospital and Tumor Insti- 
tute, under the direction of Dr. Gilbert Fletcher, 
Chairman, Department of Radiology, and in close 
cooperation with the Department of Surgery, after 
four years of work reported an improved technic for 
roentgenography of the breast yielding a higher de- 
gree of diagnostic reliability than had heretofore 
been demonstrated. This high milliamperage, low 
kilovoltage technic, utilizing a special fine grain, in- 
dustrial type film emulsion, produced a mammo- 
gram of high quality with a clear detail of the soft 
tissues of the breast. His data showed that of the 
first 1,000 breast mammographies, 43 per cent had 
sufficient clinical and mammographic indications to 
require biopsy; of the 240 breast tumors found 
among those biopsied, he had correctly diagnosed 
238 from a prebiopsy mammogram without the 
benefit of clinical appraisal. 

After Egan's report, a number of radiologists 
sought instruction in the technic from him. To meet 
this demand, a method of training in the technic and 
interpretation of the mammograms was developed. 
The experience of the radiologists thus trained sug- 
gested that clinicians would use mammography as 
a prebiopsy diagnostic aid to supplement the sub- 
jective and often indecisive evidence of palpation to 
reinforce the need for biopsy. 

Five radiologists* associated with American Can- 
cer Society and the Public Health Service then 
visited the M. D. Anderson Hospital to get first-hand 
information on Egan's work. They found that a 
unique and important factor in the successful use of 
this technic was the pattern of cooperation and com- 
munication which had been developed among sur- 
geons, pathologists and radiologists in the use of 
mammography. These visiting radiologists were cau- 
tiously optimistic in reporting their observations, but 
unanimous on the point that the technic produced a 
mammogram of higher diagnostic quality than had 
previously been available. A question still remained, 
however, as to whether radiologists generally could 

* These radiologists include: Drs. Thomas Carlile, Chief, Department 
of Radiology, Mason Clinic, .Seattle; Eugene Pendegrass, then Pro- 
fessor of Radiology, University of Pennsylvania School of Medi- 
cine; Wendell Scolt, Professor of Clinical Radiology, Washington 
University School of Medicine; James Cooney, Vice-President for 
medical affairs, American Cancer Society; and Theodore Hilbish, 
then Chief, Diagnostic X-Ray Department, Clinical Center, National 
Institutes of Health. 



U.S. NAVY MEDICAL NEWS LETTER 



reproduce the technic and obtain mammograms of 
comparable quality in their own institutions. 

It was determined that a scientifically controlled 
study should be undertaken to find answers to these 
questions: Can uniformly high quality mammo- 
grams be obtained by radiologists generally? What 
proportion of breast malignancies are correctly diag- 
nosed by mammography before biopsy? Could ex- 
isting equipment be modified adequately to permit 
the use of this technic? Was this type training ade- 
quate to produce necessary competency among 
radiologists generally? 

In undertaking this study, a division of responsi- 
bility between the Director of the National Cancer 
Institute, the Director of the M. D. Anderson Hospi- 
tal and the Chief of the Cancer Control Program 
was established. The M. D. Anderson Hospital 
would provide training for the radiologists, conduct 
workshops of participants, review mammograms 
and tissue sections, and supply all technical services 
as the clinical center of the study. 

The Cancer Control Program would collect re- 
ports of cases, provide statistical evaluation, assist 
institutions to organize for the study and supervise 
compliance with the protocol. The National Cancer 
Institute would be responsible for providing statis- 
tical consultations and assisting with analysis of the 
data. 

It was agreed that the institutions in which the 
study would be carried out would be divided into 
two groups: ten distributed throughout Texas and 
the others geographically distributed throughout the 
United States. These institutions were selected by a 
committee composed of representatives of the three 
participating agencies. 

Criteria were established as follows for carrying 
out the study: (1) The population was to be limited 
to women who were to undergo biopsy of the breast. 
(2) Mammographic studies were to be performed 
according to the technic developed by Egan. (3) 
Mammograms were to be interpreted by the radio- 
logist without benefit of clinical findings. (4) All 
breast biopsies (not selected cases) performed by 
participating surgeons were to be included in this 
study. (5) Each of the study forms was to be sent 
directly to the Cancer Control Program as com- 
pleted, for collating and analysis. 

Training of the radiologists from the participating 
institutions was accomplished in a five day visit to 
the M. D. Anderson Hospital, during which Egan in- 
structed them in his technic and interpretation of the 
mammograms. The radiologists were introduced to 



case material consisting of 3,000 mammograms. 
Special attention was given to those mammograms 
demonstrating characteristics of malignant lesions. 
The radiologists participated actively in obtaining 
and interpreting mammograms. They were also in- 
troduced to the M. D. Anderson Hospital team ap- 
proach in which the surgeons and pathologists were 
also involved in the use of mammography as well 
as the radiologists. 

Each institution was visited, prior to the accumu- 
lation of study cases, to insure that each department 
involved — radiology, surgery, and pathology — un- 
derstood the requirements of the protocol, the need 
for cooperation among the departments, and to an- 
swer questions which may have arisen. 

ACCUMULATION OF DATA 

In this paper, only data pertinent to the primary 
objectives of the study are presented. Much addi- 
tional data are available for future reports. 

Reports were made on six separate forms: A, 
Clinical Impression: B, Radiological Examination; 
C, Surgical Examination (operative findings); D, 
Pathological Report; E, M. D. Anderson Radiological 
Examination; F, M. D. Anderson Pathological Re- 
port. The forms were mailed by the participants to 
the Public Health Service as each was completed. 

The study design anticipated a population of 
2,600 patients undergoing mammography and 
biopsy. A survery of the literature indicated that 
approximately 20 per cent of these patients would be 
diagnosed with malignant neoplasms which would 
provide over 500 cancerous breasts. This number 
would be needed for the results to have statistical 
reliability. By February 1963 adequate data on 
1,580 breast examinations were completed. In addi- 
tion, there were 366 patients who were excluded 
from the study. Of these, in 187 cases no biopsy 
was performed, usually because the patient refused. 
Another ninety-seven cases were not included be- 
cause of incomplete records. Other reasons for re- 
jection of cases included no mammograms, male pa- 
tients, the specified technic not used, and protocol 
not followed. 

There were 475 malignant neoplasms diagnosed 
which represented over 30 per cent of the study 
population. Although the total number of patients 
initially planned was not obtained, the number of 
tumors was sufficient to justify termination of the 
study. 



U.S. NAVY MEDICAL NEWS LETTER 



RESULTS OF STUDY 

Of the 1,580 breast biopsied and mammographed, 
475 were diagnosed with malignant neoplasms, 
1,081 with benign lesions, and 24 with no disease. 
Radiologists were able to diagnose correctly 376 of 
the 475 malignant lesions for a true positive rate of 
79 per cent.* (Fig. 1.) 

Of the 1,105 breasts classified pathologically as 
non-malignant, the radiologists correctly diagnosed 
999 or 90 per cent. (Fig. 1.) The false positive 
rate was then 10 per cent.** The total study popu- 
lation is summarized in Figure 2. 

Table I presents this correlation on the 1,580 
breasts for which there were both a radiologic and 
a pathologic diagnosis. 

Table II shows that there was an increase with 
age in the proportion of malignant cases in which 
the mammogram was interpreted as positive. In the 

* The true positive rate is the percentage of cancers correctly diag- 
nosed by mammography. 

**The false positive rate is the percentage of nonmalignant lesions 
diagnosed as cancer by mammography. 



patients under forty-five years of age, 56 per cent of 
the malignant lesions were correctly identified on 
mammography. This true positive rate increased to 
77 per cent in the forty-five to fifty-nine year age 
group, and to 90 per cent in the sixty year and over 
age group. 

The accuracy of mammography is affected by the 
density of breast tissue. The clinicians were re- 
quested to classify each breast as being normal, 
shotty, nodular or fatty. Eighty-three per cent of the 
breasts were so classified. Table III shows that the 
true positive rate was significantly higher in the fatty 
type of breast as compared with the other three types 
described. In the fatty breast, radiologists were able 
to diagnose correctly 89 per cent of those histologi- 
cally diagnosed as cancer. 

To recapitulate, the findings of the study show: 
(1) radiologists completing a five day training pro- 
gram correctly identified 79 per cent of malignant 
lesions biopsied; (2) 10 per cent of the breasts 



TABLE I 

COMPARISON BETWEEN RADIOLOGIC INTERPRETATION AND HIS- 
TOPATHOLOGIC DIAGNOSIS BY BREAST 





Nonmalignant 


Malignant 








Histopathology 




True 


True 


Breast 






Negative 


Positive 




X-ray X-ray 


X-ray X-ray 


Rate 


Rate 




Negative Positive 


Negative Positive 






Right 


458 55 


48 173 


89.2 


78.3 


Left 


541 51 


51 203 


92.4 


79.9 


Total 


999 106 


99 376 


90.4 


79.2 



TABLE II 

COMPARISON BETWEEN RADIOLOGIC INTERPRETATION AND HIS- 
TOPATHOLOGIC DIAGNOSIS BY AGE 





Nonmalignant 


Malignant 






Age 

(yr.) 


Histopathology 

X-ray X-ray 
Negative Positive 


Histopathology 

X-ray X-ray 
Negative Positive 


True 

Negative 

Rate 


True 

Positive 

Rate 


Under 30 


240 


3 


4 4 


97.2 


50.0 


30-44 


440 


23 


28 35 


94.9 


55.6 


45-59 _ 


235 


45 


44 147 


84.5 


77.0 


60 and over 


74 


35 


20 187 


67.9 


90.3 


Total 


989 


106 


96 373 


90.3 


79.5 



U.S. NAVY MEDICAL NEWS LETTER 



CORRELATION BETWEEN HISTOPATHOLOGIC DIAGNOSIS AND 
MAMMOGRAPHY INTERPRETATION 1580 BREASTS 



HISTOPATHOLOGIC 
DIAGNOSIS 




C 



c 



J MALIGNANT 

J NON-MALIGNANT 



TOTAL POPULATION. . . 

Percent Distribution of Study Breasts by Histopathologic 
Diagnosis and Mammographic Interpretation - 1580 Breasts 



Non-Malignant 

H 05 BREASTS 

MAMMOGRAPHY 

INTERPRETATION 




Malignant 

415 BREASTS 

MAMMOGRAPHIC 

INTERPRETATION 



□ TruH Positive - H 
as positive on th 



- Histologic proven Cancer interpreted 
mammogram 



□ True Negative - Histologic non-cancer interpreted 
as noi 



□ False Positive - Histologic non-cancer Interpreted ~~ 1 False Negative - Histologic proven concer interpreted 

as positive on the mammogram l—l < 



non-ma Mgnan* tut the mammogram 
se Negative - Histologic proven ci 
as non-malignant on the mammogram 



Figures 1 6V 2 



U.S. NAVY MEDICAL NEWS LETTER 



TABLE III 

COMPARISON BETWEEN RADIOLOGIC AND HISTOPATHOLOGIC 
INTERPRETATION OF BREAST LESIONS IN CLINICAL TYPES 

OF BREAST 





Nonmalignant 


Malignant 








Histopathology 


Histopathology 


True 


True 


Type of Breast - 








Negative 


Positive 




X-ray 


X-ray 


X-ray X-ray 


Rate 


Rate 




Negative 


Positive 


Negative Positive 






Normal 


362 


29 


33 108 


92.6 


76.6 


Shotty 


203 


18 


14 43 


91.9 


75.4 


Nodular 


217 


18 


21 58 


92.3 


73.4 


Fatty 


62 


23 


12 93 


72.9 


88.6 


Not indicated 


155 


18 


19 74 


89.6 


79.6 


Total 


999 


106 


99 376 


90.4 


79.2 



which were without malignant lesions were incor- 
rectly identified as cancer on the mammogram; (3) 
the efficiency of mammography was influenced by 
the type of breast tissue; the true positive rate in- 
creased with the proportion of fatty tissue. 

COMMENTS 

The objective of the study was to see whether radi- 
ologists, operating in a variety of clinical institutions 
under conditions expected to be found in local com- 
munities, could reproduce Egan's quality of mam- 
mography. The study was not designed to see 
whether the participating radiologists could achieve 
as high a true positive rate as that of Egan. His pop- 
ulation consisted of all women coming to the tumor 
institute with any symptoms referable to the breast, 
only 30 per cent of whom had either clinical signs 
or mammographic findings which justified biopsy. 

The population dealt with in the reproducibility 
study, on the other hand, included only cases sched- 
uled for breast biopsy in the general clinical institu- 
tions. This constitutes a major difference in the two 
groups, but it was a conscious choice in the repro- 
ducibility study to require the corroborative diag- 
nosis of biopsy as a check of the quality of the mam- 
mograms produced, as well as the ability of the 
participants to interpret them. It was also decided in 
the reproducibility study to require consecutive biop- 
sies, to assure that the population studied would not 
present selected cases, but would be a cross section 
of all types of lesions mammogramed in the twenty- 
four institutions. 

There is a difference in the kinds of patients seen 
at a tumor institute and those at other hospitals. 



Cases in the tumor institute may be in more ad- 
vanced stages and, therefore, more easily diagnosed. 
A greater percentage of patients referred because of 
previous primary malignancies are likely to be in- 
cluded. The patients at the M. D. Anderson Hospi- 
tal had a higher average age than did the group in 
the general institutions. It will be noted in the re- 
sults of the reproducibility study that the effective- 
ness of mammography improves with older women. 

These points are not made to minimize Egan's 
results. It should be kept in mind that his work was 
done without benefit of prior clinical findings, and 
that the important consideration prompting the re- 
producibility study was that he had demonstrated 
both high-equality mammography and a technic 
which appeared to be reproducible by practicing ra- 
diologists. The objective of this study was to deter- 
mine the quality of the mammogram produced by 
radiologists after the prescribed training program, 
when applied to their usual patients, that is, how 
effective is the procedure with general hospital pa- 
tients? For this reason no attempt was made to 
match the study population with that examined at 
M. D. Anderson Hospital. These differences are 
mentioned here only to place in proper perspective 
the fact that the true positive rate of the study by 
other radiologists was 79 per cent, whereas Egan's 
was over 97 per cent. 

The study was set up to test mammography as a 
diagnostic aid. The results obtained do not warrant 
any conclusions regarding the usefulness of mam- 
mography to screen women fqr cancer of the breast. 
If anything, the experience of this study might be 
interpreted as placing mammography for screening 



U.S. NAVY MEDICAL NEWS LETTER 



some years away. The conventional x-ray unit per- 
mits convenient study of only fifteen to twenty pa- 
tients a day by mammography. Furthermore, the six 
views of the breast require far more study for reli- 
able interpretation than did the old screening for 
tuberculosis. There is real danger that tumors will 
be missed if there is an attempt to give a "one- 
minute review" to mammograms. The decision re- 
garding the use of mammography for screening 
should be left to those studies designed to evaluate 
the application of the procedure for this purpose. 

Another area of danger is that some may think 
that mammography can replace biopsy. Nothing 
learned in the course of this study would indicate 
that this is so. The study demonstrated that, used 
alone, mammography misses a significant number of 
lesions. There is, as before mammography, a large 
element of clinical judgment which must apply in 
the diagnosis of breast cancer. If the subjective im- 
pression of the clinician gives enough reason for 
suspicion of cancer, the clinician will be compelled 
to biopsy despite a negative mammogram. 

Although the study was limited to the question of 
the reproducibility of the Egan technic some facts 
of broader concern did emerge. All lesions mam- 
mogramed in the study were biopsied. Among them, 
there were both benign and malignant lesions, as 
diagnosed histopathologically. The ability of mam- 
mography to differentiate between the benign and 
malignant lesions would indicate the usefulness of 
mammography in the following breast conditions: 
(1) An indeterminate mass which cannot be con- 
sidered a dominant nodule, but which appears to 
carry a high potential for cancer, also, when there 
are multiple cysts or several vague masses and the 
indication for biopsy is uncertain. (2) The opposite 
breast to one where there has been a previous pri- 
mary site of cancer. Women with this history prob- 
ably should be mammographed periodically. (3) 
The large, fatty breast about which there are com- 
plaints. Malignancies cannot be palpated with ease 



in such breasts, but fortunately it is in these breasts 
that mammography is highly accurate. 

Mammography makes its claim to be a diagnostic 
aid because of the characteristic appearance of the 
malignant lesion on the mammogram. A fine stip- 
pling, when present, is almost pathognomonic of can- 
cer. There is also a characteristic infiltration of the 
surrounding tissues which is highly indicative of can- 
cer. A typical skin thickening may appear over the 
malignancy. There is also a density in the cancer 
itself, which is often helpful in mammographic inter- 
pretation. 

During the course of the study, it was found that 
adherence to the radiographic requirements is im- 
portant to get results of sufficiently high quality to 
assure selection of cases which appear to be malig- 
nant. This factor points to the need for affording 
radiologists an opportunity to both learn the proce- 
dure and use it for a period long enough to permit 
them to become familiar with it before judgment is 
passed on the usefulness of mammography. 

SUMMARY 
The findings of the reproducibility study indicate 
that the technic of mammography developed by 
Egan can be learned by other radiologists, that films 
of acceptable quality can be produced, and that the 
interpretations provide information which is useful 
in the clinical management of breast disease. 

REFERENCES 

1. Salomon, A. Beitrage zur Pathologic und Klinic des Mammakar- 
zinoma. Arch. kiln. Chir., 101; 573, 1913. 

2. Warren, S. L. A Roentgenologic Study of the Breast. Am J. 
Roentgenol., 24: 113, 1930. 

3. Leborgne, R. A. The Breast in Roentgen Diagnosis. Monte- 
video, 1953. Impresora Uruguaya S.A. 

4. Gros, C. M. and Sigrist, R. Radiography of the Breast. In: 
Gynecologic Radiography. Dalsace, J. and Garcia-Calderon, J. 
Chap. 22. New York, 1959. Paul B. Hoeber, Inc. 

5. Lane, E. L. and Pendergrass, E. R. Addition to Technic of 
Simple Breast Roentgenography. Radiology, 48: 266, 1947. 

6. Lockwood, I. H. Value of Breast Radiography Radiology, 23: 
202, 1934. 

7. Gershon-Cohen, J., Herrael, M. B. and Berger, S. M. Detection 
of Breast Cancer by Periodic X-ray Examinations: five-year 
J.A.M.A., 176: 1114, 1961. 

8. Egan, R. L. Experience with Mammography in a Tumor Institue; 
evaluation of 1,000 studies. Radiology, 75: 894, 1960. 

9. Martin, R. G. Oral Presentation at Mammography Seminar, 
M. D. Anderson Hospital and Tumor Institute, Houston, Texas, 
May 24-25, 1963. 

10. Mammography Issue. The Cancer Bulletin, vol 14, No. 6, 
November-December 1962. 



FOOD-BORNE ILLNESS 

"Recent evidence shows that, even in developed 
countries, much more salmonellosis and other dis- 
ease due to food pathogens occurs than is being re- 
ported or than had been previously suspected; 
possibly less than 1% of such cases are reported. 
Epidemiological studies of food-borne illness are 
complicated by the fact that foods produced and 



processed in one country may be consumed in an- 
other. Better food hygiene and temperature control 
become increasingly necessary as the trend towards 
mass-cooked meals in schools, factories, institutions 
and homes continues." — From Environmental 
Change and Resulting Impacts on Health: Report 
of a WHO Expert Committee (Wld Hlth Org. techn. 
Rep. Ser., 1964, No. 292), p. 17. 



8 



U.S. NAVY MEDICAL NEWS LETTER 



FROM THE NOTE BOOK 



DRUG WARNING 

I am writing to remind you of the close similarity 
and toxicity of aminopyrine and dipyrone, an amino- 
pyrine derivative. 

This letter is being issued on the recommendation 
of a distinguished Ad Hoc Scientific Advisory Com- 
mittee on Aminopyrine and Dipyrone and with the 
full cooperation of the American Medical Associa- 
tion. 

The Ad Hoc Committee under the Chairmanship 
of Maxwell M. Wintrobe, M. D., Professor and 
Head, Department of Medicine, University of Utah, 
found that aminopyrine and dipyrone, a sodium sul- 
fonate derivative of aminopyrine, are capable of 
causing fatal agranulocytosis. Relatively small 
amounts of these drugs given intermittently over a 
period of time, as well as regular and continued ad- 
ministration, can precipitate the reaction of agranu- 
locytosis. They recommend that other antipyretics 
and analgesics which are much safer should be used 
in preference to aminopyrine or dipyrone. The only 
condition in which aminopyrine or dipyrone are 
known to be possibly indicated are febrile convul- 
sions in children, where a parenteral antipyretic may 
be needed, and in rare instances of Hodgkin's dis- 
ease and similar malignant diseases in which the 
fever cannot be controlled by any other means. 

This Administration is seeking to require manu- 
facturers of aminopyrine and dipyrone preparations 
to change the labeling and advertising of these drugs 
to warn that they may cause fatal agranulocytosis 
and to offer them solely for their antipyretic effect 
in serious or life-threatening situations where salicy- 
lates or similar durgs are known to be ineffective or 
are contraindicated or not tolerated. 

The Ad Hoc Committee recommended that it be 
reconvened in about a year's time to ascertain 
whether the use of aminopyrine and dipyrone and 
the cases of fatal agranulocytosis associated with the 
use of these drugs have been noticeably reduced as 
a result of the changes in their labeling and advertis- 
ing, and of efforts to remind physicians of their 
toxicity through the media of professional commu- 
nication. 



It may be well to note that the Commissioner has 
declared aminopyrine and dipyrone to be new drugs 
under the law. This is medically desirable and 
sound. This decision will enable our Bureau of 
Medicine to continuously analyze the adverse reac- 
tion incidence of these drugs through reports re- 
ceived from the manufacturer, as well as such data 
compiled through the reporting mechanisms of the 
Food and Drug Administration and the American 
Medical Association. It will make it possible to ob- 
tain the kinds of information needed by the Com- 
mittee for its re-evaluation of the matter. 

Prescribers should take careful note of the generic 
names on labels of analgesic and antipyretic drugs 
since the trade names commonly do not reveal 
whether they contain aminopyrine or dipyrone. 
Aminopyrine is marketed under such names as: 
Amidofebrin, Amidopyrazoline, Amidopyrine, Amy- 
tal w/aminopyrine, Anafebrina, Cibalgine (amino- 
pyrine-allobarbital), Dimapyrin, Febrinina, Nova- 
midon, Piridol, Polinalin, Pyradone and Pyramidon. 

Dipyrone is marketed as: Alginodia, Bonpyrin, 
Dipralon Forte, Fevonil, Key-Pyrone, Migesic, 
Narone, Nartrate, Novaldin, Novalgin, Novemina, 
Paralgin, Pydirone, Pyralgin and Sulyprin. 

For your further information concerning this sub- 
ject, may we recommend that you consider Dr. 
Charles Huguley's paper entitled: "Agranulocytosis 
Induced by Dipyrone, A Hazardous Antipyretic and 
Analgesic" published in the Journal of the American 
Medical Association (189: 938, 1964). 

Copies of the report and recommendations of the 
Ad Hoc Scientific Advisory Committee on Amino- 
pyrine and Dipyrone may be obtained by writing to 
the Office of Public Information, Food and Drug 
Administration, Department of Health, Education, 
and Welfare, Washington, D.C. 20204. 

S/Joseph F. Sadusk, Jr., M.D. 
Medical Director 

ORAL SURGERY LECTURE AT U.S. NAVAL 
HOSPITAL, SAN DIEGO 

CAPT Philip J. Boyne, DC USN, of the USS Bon 
Homme Richard (CVA-31), recently presented a 



U.S. NAVY MEDICAL NEWS LETTER 



lecture at the Staff Meeting of the Oral Surgical 
Service of the U.S. Naval Hospital, San Diego. 

CAPT Boyne's lecture included a presentation of 
his paper which won the Research Award of the 
Year from the American Society of Oral Surgeons. 
The paper is entitled, "A Study of Osseous Healing 
Following Osteotomy for the Correction of Mandi- 
bular Prognathism". 

CAPT Walter W. Crowe, Chief of the Oral Sur- 
gical Service at the U.S. Naval Hospital at San 
Diego, presided at the meeting, which was held at 
the Naval Hospital, San Diego. — Official U.S. Navy 
News Release, Release No. P-7-65, March 23, 
1965. 

From: Commanding Officer 

To: Johnson, Ray D, 926 19 33, HMCA USN 

Subj: LETTER OF APPRECIATION 

1. You were a member of a special team which, at 
the request of the Somali Government, worked in 
Somali Republic from 10 to 24 January 1965 for 
the purpose of determining the cause of and making 
recommendations concerning the control of an epi- 
demic of dysentery in that country. 

2. I wish to add my appreciation to that already 
conveyed to you by the Somali Government and Mr, 
H. G. Torbert, Jr., American Ambassador to Somali 
Republic, for the outstanding contributions made by 
you during the conduct of the survey. 

3. For your performance, which is in keeping with 
the highest traditions of the Naval Service, I extend 
to you a hearty "Well Done!" 

4. A copy of this letter will be made a part of your 
official record. 

NAVAL INTERN MATCHING SUCCESS 

The Surgeon General is pleased to announce that 
the Navy matched 100% of the 176 interns re- 
quested under the National Intern Matching Pro- 
gram. Out of the more than 300 interns who listed 
the Navy in their choice, a majority of the 176 
selected Navy as first choice. Of those matched to 
the Navy, almost 90% were assigned to a hospital 
of their first three choices and no one was assigned 
to a hospital which he had not requested. This is a 
creditable record in view of the fact that there were 
5,696 internships unfilled this year. 

Effort has been made to improve the attractive- 
ness of the Naval internship. The Intern Training 
Committees in our hospitals are aware that we are in 
a competitive market and have done all in their 



power to make the training programs professionally 
rewarding. Watch standing requirements have been 
changed from one in two to one in three nights on 
duty. Applicants are assured in advance that if we 
cannot assign them to a hospital within their list of 
choices, they will be released, upon request, from 
their matching contract. The clinical and research 
clerkships afford the potential candidate an opportu- 
nity to view the Naval internships at close range. 

The Surgeon General sends his thanks to the Dis- 
trict Medical Officers, The Commandants' Represent- 
atives in Medical Schools, the Hospital Command- 
ing Officers and their Staffs and the many people in 
the Navy's Recruiting Service who make possible the 
success in our Intern Program. — Professional Div., 
BUMED. 

SUGGESTED FORMAT FOR COMMAND 

PROFESSIONAL RELATIONSHIP WITH 

REPRESENTATIVES OF PHARMACEUTICAL 

MANUFACTURERS 

1. Background. Detailmen can be of great assist- 
ance to the professional staff of any medical activity, 
but on the other hand they can also be a source of 
bother if they are not provided with a set of "ground 
rules" by which to operate. With very few excep- 
tions, "ground rules" are welcomed by the detail- 
men, as well as by the staff in that product informa- 
tion is passed on smoothly, and at such times as 
are convenient to all concerned. This hospital has 
such a set of rules, which have been proved over a 
period of time, and are submitted as a possible aid 
to other activities who might find their present sys- 
tem unsatisfactory. 

2. Method. 

a. All detailmen are required to check-in at the 
Pharmacy before visiting any other area of the hos- 
pital. 

b. Explicit instructions are personally outlined by 
the Chief of Pharmacy Service: 

(1) The Pharmacy must be made aware of the 
items that are to be detailed that day to the staff. In 
the case of new products, complete literature must be 
on file in the Pharmacy before any detailing is done. 
This is to provide a ready reference for the staff 
should questions arise. 

(2) Only a very small quantity of samples are 
left with the physician. Sampling in quantity is done 
only with the Pharmacy. This allows the Pharmacy 
to establish usage rates should the item be requested 
for stock, and permits a replenishment of the samples 



10 



U.S. NAVY MEDICAL NEWS LETTER 



should the physician wish to extend his clinical eval- 
uation of an item. 

(3) Each detailman is briefed as to the best 
hours to visit each service, and that he must detail 
the Chief of Service prior to detailing the individual 
physicians of that service. 

(4) Normally, appointments are not made; 
however, the Pharmacy does phone an individual 
physician should the time of the visit be during the 
busiest hours of his day. 

(5) Detailmen are informed as to which days 
of the week other detailmen are usually on board, 
to help space out their visits to the hospital. 

(6) The Pharmacy maintains a company card 
file of inquiries and when the detailman checks in, he 
is informed of these inquiries and directed to the 
individual concerned. 

3 . Hospital Exhibits. 

a. Through trial and error, this hospital has de- 
veloped a method of permitting the various pharma- 
ceutical companies to display the latest trends in 
therapeutics to the staff of this hospital. 

b. To provide a relaxing atmosphere and traffic- 
free space, the lounge of the BOQ was made avail- 
able for these exhibits. 

c. The exhibits are held on the third Tuesday of 
each month, a day determined to be most advantage- 
ous to all. The hours extend from 1100 to 1400, to 
give sufficient time for all personnel to attend prior 
to, during, and after lunch. 

d. The exhibits are given wide publicity through 
individual notices to the staff and notices published 
in the Hospital Daily Bulletin. A form letter is 
mailed to each of the representatives who normally 
call on this hospital and others which the command 
feels could benefit our staff. Because of the numer- 
ous medical activities within the Camp Pendleton 
complex, each is notified monthly of the pending ex- 
hibits. 

e. Although this arrangement was made primarily 
for the medical and dental officers, and the pharma- 
ceutical representatives we found that companies 
with allied products, other than pharmaceuticals, 
were requesting permission to exhibit their products. 
In addition, the Nurse Corps officers showed great 
enthusiasm for the opportunity to procure drug 
literature and ask questions concerning the problems 
they experience in their field. Through the visits of 
the Nursing Educational Coordinator, arrangements 
were made for non-commercial lectures to be pre- 



sented to staff personnel by some of the pharma- 
ceutical representatives. 

f . The attendance by both the companies and staff 
has been gratifying. For instance, in November, 28 
companies exhibited their products to over 150 offi- 
cers of the Medical Department. 

g. These exhibits have been enthusiastically re- 
ceived by all hands, and letters have been received 
from all of the companies expressing their gratitude 
as they felt that our method provided the best for- 
mat they had experienced for detailing pharmaceu- 
ticals. 

h. A photograph taken at one of the exhibits is 
included. 

4. Conclusions, 

a. The responsibility for coordinating the relation- 
ship of the detailmen with the staff must lay with the 
Pharmacy. 

b. Established ground rules provide a harmonious 
and beneficial atmosphere for detailing. 

c. The exhibit method of detailing takes less of the 
medical officer's time; he can see 20 to 30 represent- 
atives in one or two hours. 

d. The set date allows the staff to plan for the 
meeting. 

e. By having groups of medical officers inquiring 
about items, they seem to stimulate questions they 
individually may not think of, and hear comments 
they might not otherwise hear. 




U.S. NAVY MEDICAL NEWS LETTER 



11 



f. The procedure allows the medical and dental 
officers to be selective and see only the representa- 
tives who have items in their particular fields of in- 
terest, — From: Commanding Officer, U.S. Naval 
Hospital, Camp Pendleton, Calif. 

NAVAL MEDICAL RESEARCH REPORTS 

U.S. Naval Medical Research Institute, National 
Naval Medical Center, Bethesda, Md. 

1. "False Positive" Complement Fixation with 
Psittacosis-Trachoma Antigens Due to Anti- 
bodies in Complement Preparations: MR 
005.09-1200.05 Report No. 5, December 
1963. 

2. Preservation of Blood by Freezing: A Review: 
MR 005.02-0001.07 Report No. 12, 1964. 

3. Serological Studies on Group and Species- 
Specific Antigens of Trachoma and Inclusion 
Conjunctivitis (Trie) Agents: MR 005.09- 
1200.05 Report No. 6, 1964. 

4. Relationship of Ego Identity to Psychosocial 
Effectiveness: MR 005.12-2601.01 Report 
No. 1, 1964. 

5. Digenetic Trematodes of Fishes From Palawan 
Island, Philippines. IV. Some Immature 
Didymozoidae, A Bucephalid; A New Hemiu- 
roid Genus and Subfamily: MR 005.90-1606. 
01 Report No. 13, April 1964. 

6. Amphistome (Trematode) From Domestic 
Ruminants of North Borneo: MR 005.09- 
1606.01 Report No. 8, May 1964. 

7. Tris (Hydroxy methyl) Aminomethane as a 
Standard for Kjeldahl Nitrogen Analysis: MR 
005.02-0011.01 Report No. 4, July 1964. 

8. Hemolysis by Holothurin A Digitonin, and 
Quillia Saponin: Estimates of the Required 
Cellular Lysin Uptake and Free Lysin Con- 
centrations: MR 005.06-0010.01 Report No. 
33, July 1964. 

9. Nutrition of Recruits During a Summer Habit- 
ability Study: MR 005.01-0001.02 Report No. 
3, Aug 1964. 

10. Urolithiasis in the Rat. IV. Influence of Amino 
Acid Supplements on the Occurrence of Citrate 
Calculi: MR 005.02-0001.09 Report No. 3, 
August 1964. 

1 1 . The Use of Rose Multipurpose Chambers and 
Dialysis Membranes in the Cultivation of 
Exoerythrocytic Stages of Avian Malarial Para- 
sites: MR 005.09-1030.02 Report No. 10, 
September 1964. 



12 



12. Elevation of Body Temperature in Health: 
MR 005.01-0001.02 Report No. 2 October 
1964. 

13. Interactions of Aryl Esters in the Tropine and 
^-Tropine Series With Tissue Chemoreceptors. 
The Ortho Effect. VII.: MR 005.06-0010.01 
Report No. 34, November 1964. 

14. Binding of Bromocresol Green by Human 
Serum Albumin: MR 005.02-0011.01 Report 
No. 6, December 1964. 

15. A Plea for the Continued Use of Local Anes- 
thesia in Major Surgery: MR 005.02-0020.01 
Report No. 5, December 1964. 

16. Command Historical Report 1964. (OPNAV 
Report 5750-5), 1965. 

U.S. Naval Medical Research Unit No. 3, Cairo, 

Egypt. 

1. Possible Factors Associated with the Relatively 
Low Prevalence of Dental Caries Among Egyp- 
tians 2. Fluoride in Drinking Water as Related 
to the Fluoride Content of Teeth: MR 005.12- 
5001.6, November 1964. 

2. Notes on African Haemaphysalis Ticks. VI. H. 
spinulosa Neumann, and its Relation to Biologi- 
cal and Nomenclatorial Problems in the H. 
leachii Group of Africa and Asia (Ixodoidea, 
Ixodidae): MR 005.09-1402.3, December 
1964. 

3. Studies on Southeast Asian Haemaphysalis Ticks 
(Ixodoidea, Ixodidae). Redescription, Hosts, 
and Distribution of H. traguli Oudemans. The 
Larva and Nymph of H. vidua W. and N. Iden- 
tity of H. papuana toxopei Warburton (New 
Combination): MR 005.09-1402.3, December 
1964. 

4. Phlebotomus Sandflies of the Paloich Area in 
the Sudan: MR 005.09.1603-1, December 

1964. 

U.S. Naval Medical Field Research Laboratory, 
Camp Lejeune, North Carolina. 

1. The Prediction of Disease: MR 005.09-1160. 
1.2, December 1964. 

2. The Effect of Strenuous Exercise on Serum 
Lipids and Enzymes: MR 005.09-1160.1.3, 
January 1965. 

3. Evaluation of a Mobile-Portable X-Ray Unit: 
MR 005.12-6001.6, January 1965. 

4. Evaluation of a Modified Ambu Resuscitator 
Kit: MR 005.12-6001.6, January 1965. 

U.S. NAVY MEDICAL NEWS LETTER 



5. Evaluation of a Portable X-Ray Apparatus for 
Field Use: MR 005.12-6001.6, January 1965. 

6. User Test of Casualty Moving Vehicle, Rough 
Terrain: MR 005.12-6001.6, January 1965. 

U.S. Naval Air Development Center, Aviation Medi- 
cal Acceleration Laboratory, Johnsville, Penna. 

1. Effects of Positive G on Chimpanzees Immersed 
in Water: MR 005.13-9020.2 Report No. 10, 
September 1964. 

2. Protection Afforded by Fire Resistant Poly amide 
(HT-1) Flight Coveralls in Helicopter Crash 
Fire: MR 005.13-1005.1 Report No. 31, No- 
vember 1964. 

3. Studies in Thermal Protection: I Experimental 
Approach and Procedures: MR 005.13-1005.1 
Report No. 32, February 1965. 

4. Studies in Thermal Protection: II. Protective 
Capacity of Two Polyester Fiber Materials: MR 
005.13-1005.1 Report No. 33, February 1965. 

U.S. Naval Submarine Base, Naval Medical Re- 
search Laboratory, New London, Conn. 

1. Evaluation of Bicaloric Test of Vestibular Func- 
tion: MR 005.14-1001-2.14 Report No. 411, 
Sept 1963. 

2. Behavioral Periodicity : I. Bibliography of Litera- 
ture Pertaining to Human Beings: MR 005.14- 
2100-3.09, January 1964. 

3. An Annotated Department Reference File for 
Polaris Medical Officers: MR 005.14-3002- 
4.13 Report No. 429, May 1964. 

4. The Psychological Dimensions of Color: MR 
005.14-1001-1.34, June 1964. 

5. Effect of Field Size and Position on Mesopic 
Spectral Sensitivity: MR 005.14-1001-1.35, 
June 1964. 

6. Effect of Surround and Stimulus Luminance on 
the Discrimination of Hue: MR 005.14-1001- 
1.36, July 1964. 



7. Discrimination of Color: IV. Sensitivity as a 
Function of Spectral Wavelength: MR 005.14- 
1001-1.37, July 1964. 

8. Psychological and Psychophysiological Effects of 
Confinement in a High-Pressure Helium-Oxygen- 
Nitrogen Atmosphere for 284 Hours: MR 005. 
14-2100-3.10, November 1964. 

U.S. Naval Aviation Medical Center, Naval School 
of Aviation Medicine, Pensacola, Fla. 

1. Vestibular Habituation During Repetitive Com- 
plex Stimulation: A Study of Transfer Effects, 
September 1964. 

2. An Investigation of Unpredicted Differences in 
Attrition Rates Among Students from Different 
Procurement Sources: MR 005.13-3003 Subtask 
1 Report No. 40, October 1964. 

3. Comparative Histological Study of the Rein- 
forced Area of the Saccular Membrane in Mam- 
mals: MR 005.13-6001 Subtask 1 Report No. 
101, October 1964. 

4. Dosimetric Evaluation of the Alpha Flux in Solar 
Particle Beams: MR 005.13-1002 Subtask 1 
Report No. 30, November 1964. 

5. The Ultrastructure of the Otolith Organs in 
Squirrel Monkeys After Exposure to High Levels 
of Gravitoinertial Force: MR 005.13-6001 Sub- 
task 1 Report No. 102, November 1964. 

6. Quantitative Interpretation of the Exercise Elec- 
trocardiogram: MR 005.13-7004 Subtask 8 Re- 
port No. 3, November 1964. 

7. Evaluation and Prediction of Physical Fitness, 
Utilizing Modified Apparatus of the Harvard 
Step Test: MR 005.13-3001 Subtask 1 Report 
No. 4, December 1964. 

Aerospace Crew Equipment Laboratory, U.S. Naval 
Air Engineering Center, Philadelphia, Penna. 
1. Indirect Basophil Degranulation Test in Penicil- 
lin Allergy: MR 005.12-1406 Subtask 4, April 
1964. 



INFORMATION ON CHOLERA 

After an interval of 14 years, cholera broke out 
in Bombay City in May 1964. There were 2000 
cases, with a case-fatality rate of 5%. Phage-typing 
of 111 vibrio strains isolated during the outbreak 
was carried out by the WHO International Refer- 

U.S. NAVY MEDICAL NEWS LETTER 



ence Centre for Vibrio Phage-Typing at Calcutta. 
The results suggest that the Bombay epidemic orig- 
inated in neighbouring areas, where strains of phage- 
types and sero-types identical to those isolated in 
Bombay were found.— WHO Chronicle, 19(3); 124, 
March 1965. 



13 



DENTAL SECTION 



ORAL HYGIENE OF THE INTERDENTAL 
AREA 

Joe H. Smith, Tod W. O'Connor, and William 
Radentz, Jour Periodont, Sept-Oct 1963. 

The interdental papilla is often diminished in size 
or completely lost due to processes of aging, disease 
or periodontal surgery, resulting in an exaggerated 
interproximal space and an awkward problem in 
maintenance of adequate oral hygiene. This prob- 
lem is compounded when adjacent root surface or 
surfaces are concave. The many aids advocated for 
use in cleansing such areas include the toothbrush 
and its variations, wood stimulators, rubber stimula- 
tors, waxed or unwaxed dental floss or tape, twisted 
wire stainless steel brushes of .016 gauge, pipe 
cleaners, etc., all of which help but are not effective 
to the degree required to effectively clean embrasures 
devoid of normal papillae. The authors demonstrate 
a simple and excellent technique utilizing eight inch 
lengths of three ply knitting yarn. The length of 
yarn is folded double then an eight inch length of 
unwaxed dental floss is threaded through the loop 
(or bight) of yarn. Folded back on itself and se- 
cured to the yarn with a simple overhand knot. The 
floss, which can usually be easily slipped through 
the embrasure, now acts as a pull through for the 
double yarn. The adjacent teeth are polished sepa- 
rately with a buccal lingual motion. The double yarn 
is excellent for cleaning fixed or partial denture abut- 
ments, isolated teeth or those separated in diastema. 
The yarn provides an effective vehicle for carrying 
desensitizing or stannous fluoride preparation to in- 
terproximal or other inaccessible tooth surfaces. 
The use of a disclosing tablet or solution is a most 
dramatic means of demonstrating to a patient the 
need for this technique in home care. Patient use of 
the disclosing tablet is particularly helpful in deter- 
mining for himself when the surfaces are clean. 
Should knitting wool be objectionable to some pa- 
tients due to loose strands, synthetic fibre such as 
rayon or nylon can be used as effectively. 

This reviewer has used the technique for over a 
year and found that it does in fact solve what here- 



tofore had been a real problem for most postsurgical 
periodontal patients. An added benefit can be de- 
rived if the patient will use the yarn to bring pres- 
sure apically, against the papilla, and thus tend to 
form the tissues. During healing following period- 
ontal surgery, this technique seems to lessen the in- 
cidence of overgrowth and hasten the maturation of 
the tissues. 

(Submitted by: CDR Walter N. Johnson DC 
USN, U.S. Naval Dental Clinic, Camp Pendleton, 
California.) 

FACTORS INFLUENCING CENTRIC RELA- 
TION RECORDS IN EDENTULOUS MOUTHS 

A, A. Yurkstas, K. K. Kapur, Jour Pros Den 
14(6): 1054-1068,1964. 

The authors report their findings on an investiga- 
tion of discrepancies that are found when variables 
are introduced in two popular technics of registering 
centric relation. These are the intraoral Gothic arch 
(needle point tracing) and the wax recording 
method. Both systems have been criticized in varying 
degree and a review of the opinion of several investi- 
gators is given. This study was carried out to evalu- 
ate the effect of various factors on the reliability or 
duplic ability of the two methods. The basic premise 
used was that the more accurately a record could be 
duplicated the more likely it was to be correct. 

Stabilized base plates were constructed for 35 pa- 
tients. Five patients were evaluated for each vari- 
able: wax recording technic, intraoral tracing proce- 
dure, inclination of the central bearing plate, inclina- 
tion of the tracing plate, amount of pressure exerted, 
and type of ridge. 

The paper gives a comprehensive report on the re- 
sults of the investigation. Tables, bar graphs, and 
tables of critical ratios which compare the various 
procedures illustrated the findings in an outstanding 
manner. 

The purpose of this study was not to evaluate the 
accuracy of one recording procedure over another 
but to emphasize the fact that there are many vari- 
ables which can enter into any recording procedure 



14 



U.S. NAVY MEDICAL NEWS LETTER 



when care is not taken in its execution. In the wax 
recording procedure, the degree of hardness, the de- 
gree of bilateral homogeneity, the amount of occlusal 
contact, and the presence or absence of anterior free- 
dom influenced duplicability to a significant level. 
In the intraoral (needle point) tracing procedure, 
the location of the central bearing point anteriorly, 
posteriorly, or laterally; the inclination of the central 
bearing point in relation to the tracing plate 
(whether it be perpendicular or mounted on an angle 
to it); and the inclination of the tracing plate in 
relation to the underlying bearing surfaces played an 
important part in determining the duplicability of 
the records. Heavy closing pressure adversely in- 
fluenced the duplicability of the records under these 
conditions. It is recommended that centric records 
be made with accurately fitting base plates under 
minimal pressure which is centralized and distributed 
uniformly to the underlying denture bearing areas. 

An outstanding discussion of the paper is given 
by Dr. George A. Hughes. 

(Abstract submitted by: CAPT C. D. Hemphill, 
DC USN.) 

ZIRCONIUM SILICATE FOR USE AS A 

CLEANING AND POLISHING AGENT FOR 

ORAL HARD TISSUES 

/. C. Muhler, N. J. Budding and G. K. Stookey, 
Jour Periodont 35(6): 481-485, 1964. 

A variety of methods can be used to measure 
enamel luster, one being to evaluate the abrasive for 
its ability to polish a dull surface and at the same 
time to determine the dulling quality of the abrasive 
on a highly polished surface. The optimal dental 
abrasive would be one which would raise a dull sur- 
face to a high polish and not dull a highly polished 
surface. 

The abrasive in the prophylactic paste must clean 
teeth and hopeful polish them also. This paper con- 
cerns the use of a new abrasive, Zirconium Silicate 
(ZrSi6,), as the basic constituent of a prophylactic 
paste and describes its unique characteristics of be- 
ing an excellent cleaning and polishing agent, but 
producing minimum damage to tooth structure. 

To evaluate the ability of ZrSiO, to clean and 
polish teeth, it was compared with the ability of flour 
an pumice and lava pumice in removing six different 
common forms of tooth stain or pigmentation. In 
these comparisions, patients having the particular 
type of stain or enamel pigmentation had either their 
respective left anterior maxillary central incisor. 



right anterior maxillary central incisor, or their two 
mandibular central incisors cleaned with the three 
respective abrasives. Patients were randomly divided 
to evaluate the cleaning and polishing ability of the 
three abrasives. All abrasives were formulated to 
have the same powder/ water ratio (7:1) and all 
tooth surface were polished for exactly thirty seconds 
and then evaluated for effectiveness of cleaning. 

A total of 61 patients had teeth with green stain. 
This stain, along with the black form and pigmenta- 
tion from SnF 2 is known to be the most difficult to 
remove. Flour of pumice cleaned 19 cases, lava 
pumice 34, and ZrSi0 4 60. Black stain, most fre- 
quently resulting from the excessive use of tobacco, 
is also quite difficult to remove satisfactorily in many 
instances. Of the patients having black stain, two 
were removed with flour of pumice, five with lava 
pumice, and twelve with ZrSiOj. Similar proportion- 
ate results were found for removal of pellicle, yellow 
stain, and brown stain. 

The ability of ZrSi0 4 to clean and polish silver 
amalgam restorations and gold inlays was interest- 
ing. The use of ZrSiO, produced an excellent luster 
on even very old silver amalgam restorations and 
gold inlays. Some dentists have questioned the wis- 
dom of polishing silver amalgams, in that it may 
weaken the margins of the restoration, but prelim- 
inary work using ZrSiOj showed that due to its low 
abrasiveness it was less damaging in this regard than 
other commonly used agents. Moreover, a clean and 
high polished amalgam reduces food retention and 
may play an important role in reducing dental caries 
at the margins of restorations. This is an area need- 
ing re-evaluation in light of the new data resulting 
from the use of ZrSi0 4 . 

In cases with stubborn stains and pigmentation, 
the minimum amount of water should be added to 
the powder to produce maximum cleaning. A 
"soupy" mix may be required for maximum polish- 
ing. It has been found that a slow rotation of the 
prophylaxis cup produces a tooth surface with maxi- 
mum luster in contrast with using a cup at excessive 
speeds. 

(Submitted by: CAPT Perry C. Alexander, U.S. 
Naval Dental Clinic, Long Beach, California.) 

SOME PRECAUTIONS TO OBSERVE IN 

APPLICATION OF THREE-AGENT 

STANNOUS FLUORIDE TREATMENT 

The dental officers of Naval Training Center, San 
Diego, and the 12th Dental Company, Fleet Marine 
Force, Atlantic, have brought to this Bureau's atten- 



U.S. NAVY MEDICAL NEWS LETTER 



15 



tion some untoward experiences that they have had 
because of lack of care on the part of dental per- 
sonnel providing treatment. In one case, the dental 
technician placed the stannous fluoride prophylaxis 
paste in the rubber cup and started the engine before 
the rubber cup was in the patient's mouth. A few 
particles of the paste flew into the patient's eye and 
was not washed out until the treatment was com- 
pleted. As a result, the eye was chemically burned. 
However, the patient recovered in three days with 
proper treatment. To avoid accidents of this type, 
do not start the engine before the rubber cup with the 
paste is in the patient's mouth; the dental technician 
should always wear glasses himself; and if the paste 
should accidentally enter an eye, it should be washed 
out immediately and the man should be referred to 
the medical officer. 

At the Naval Training Center, San Diego, it was 
noted that if stannous fluoride in paste or aqueous 
solution was dropped on uniforms, it caused staining 
of the uniform which could not be removed. This 
was corrected by draping the patient with a plastic 
apron before the treatment was started. In addition, 
some dental technicians whose primary duty was the 
application of the three-agent stannous fluoride 
treatment noticed that their hands became sore after 
a period time if they did not apply a hand lotion or 
wear rubber gloves. 

—Dental Section, BUMED. 

DENTAL HEALTH EDUCATION MATERIAL 

The Chief, Dental Division, Bureau of Medicine 
and Surgery, is vitally interested in dental health edu- 
cation material that has been developed by individ- 
ual dental officers in carrying out their Preventive 
Dentistry Programs; therefore, it is requested that a 
copy of articles appearing in station papers, pam- 
phlets, booklets, and audiovisual aids be sent to 
Code 61 1 of the Dental Division for compilation and 
dissemination on a Navy- wide basis via the Medical 
News Letter or other means. 

An outstanding example of initiative and imagina- 
tion on the part of a dental officer in this direction 
is the successful effort of Commander R. Austin DC, 
USN. While Preventive Dentistry Officer, Naval 
Training Center, Great Lakes, Illinois, he developed 
a dental health message to be placed on paper milk 
cartons which was accepted by the dairy supplying 
milk to the Navy Commissary. Now every milk 
carton sold at this activity carries the below pictured 
daily dental health reminder to all who purchase 
milk at this activity's Commissary. There must be 




Daily care 

EAT BALANCED 
DIET 

MOW ism* 

W% TIME.... 

THOHOUGHLY massage 
the GUMS 

ALWAYS BRUSH or RINSE 
.AFTER MEALS or SNACKS 

LOOK at YOUR 
I TEETH -OTHERS DO^y] 

UAVE SOUND TEETH *. J 
rjin o SOUND BODY.... f, 

AN OUNCE of PREVENTION 
L :s WORTH POUND Of CURE.. 

I OVE to HAVE a 
fc SPARKLING SMILE? 

T°°TH DECAY 
1 MEANS DISMAY., 

WWE REGULAR 
DENTAL CHECK-UPS.' 

] A PJILIC KftVICI MI5SA0C FIOM 1HI 

l.t. HIT »i 

, umii taun mm tnn 



ENJOY "w BENEFITS * 
j K of BETTER TEET 





fCavot 




many other dairies that would do the same, and it 
is reasonable to assume that there are many other 
equally good ideas and dental health messages that 
are not getting the dissemination they should have. 



KNOW YOUR DENTAL CORPS 

(Second in a Series) 

3D DENTAL COMPANY, 3D MARINE 
DIVISION, FLEET MARINE FORCE, PACIFIC 

The 3D Dental Company has the honor of being 
part of one of our Nation's most powerful retaliatory 
forces, the Fleet Marine Force, Pacific, specifically 
the 3D Marine Division. In its role with the 3D 
Marine Division, the 3D Dental Company's mission 
is to provide complete dental service to the Marines 
in the field. 

From combat experiences encountered during the 
World War 11 and the Korean Operations, it had be- 
come evident that a reorganization of the dental 
service of the fleet marine force was necessary. Dur- 
ing these periods of hostilities, dental personnel were 
organic to units of the division, and consequently 
accompanied their parent unit into early phases of 
combat operations. In many instances dental per- 
sonnel were limited in performing dental services 
due to the fluctuating and unstable combat engage- 
ments. Not being able to perform their primary 
duties, dental personnel were actually a hindrance to 
initial landing operations. 



16 



U.S. NAVY MEDICAL NEWS LETTER 



Realizing the ineffectiveness of the dental service 
with the fleet marine force, studies were initiated in 
1951 to improve the organization of the dental serv- 
ice and its capabilities in field operations. In 1955 
after studies and modifications were completed, den- 
tal companies were first authorized for ground 
troops. 

The Dental Company is a separate force level 
organization composed of naval dental personnel and 
is commanded by an officer of the Naval Dental 
Corps. Designated as a ground unit, the Dental 
Company has the capability of supporting a major 
FMF unit such as the 3D Marine Division. Being 
part of the FMF requires the 3D Dental Company to 
be a flexible organization that can deploy, com- 
pletely, with an entire marine division or provide 
dental detachments for support of battalion or regi- 
mental type operations in trouble spots in the West- 
ern Pacific. 

Although the Company enjoys the use of six 
modern and well equipped dental clinics while in 
garrison on Okinawa, deployments of dental detach- 
ments require that dental field equipment also be 
utilized in the treatment of dental patients. While 
operating with Battalion Landing Teams or Marine 
Expeditionary Units, dental officers and dental tech- 
nicians assigned to the Dental Detachment must be 
fully prepared to deploy with complete technical field 
dental equipment, as well as Marine Corps field 
equipment, to furnish dental support under all field 
conditions and environments unique to Marine 
Corps operations. 

In preparation for duty with the 3D Dental Com- 
pany, all officers and enlisted personnel receive a 
course of instruction at Field Medical Service School, 
Camp Pendleton, California in the basic principles 
of field medicine and the fundamental concepts of 
Marine Corps organization and operation. After re- 
porting to the Company, dental personnel have their 



training continued and reinforced through field train- 
ing associated with actual operational deployments 
with FMF units. Annually a company level field 
training exercise is conducted to test the combat 
readiness of the men and equipment of the 3D Den- 
tal Company. 

A prime example to this type of readiness and 
mobility was demonstrated in a recent joint U.S. 
Marine Corps and U.S. Air Force exercise called 
Reflex I. During this highly successful training ex- 
ercise a dental detachment consisting of one dental 
officer and one dental technician accompanied a 
Marine Expeditionary Unit to Mactan Island, Re- 
public of the Philippines. Within hours after their 
alert the dental detachment was completely outfitted 
and airlifted by Air Force C-130's, with a fully 
equipped landing team of the 3D Marine Division 
from Okinawa to Mactan Air Field. The exercise 
was designed to perfect the swift air lift of Marines 
from Okinawa to potential Asian trouble spots. 

During their brief stay in Mactan the dental de- 
tachment set up its field equipment and was prepared 
to render full dental support to the Marine Expedi- 
tionary Unit. Before concluding the operations 
Colonel E. B. Wheeler, USMC and Captain J. N. 
Gossom, DC, USN as representatives of the 3D 
Marine Division made presentations of dental and 
medical supplies and a set of encyclopedias to the 
local Philippine town of Lapu-Lapu. This gesture of 
goodwill was made through the town Mayor at a 
meeting with the local town council. 

Since 1955 when the dental companies were first 
established, dental personnel serving in these units 
have found duty with the Marines a rewarding ex- 
perience. Especially in these critical times, members 
of the 3D Dental Company are proud to serve with 
the FMF. 

—Dental Section, BUMED. 



PERSONNEL AND PROFESSIONAL NOTES 



Selections for Advanced Training. Based on the 
recommendations of the Dental Training Committee, 
which convened on 2 March 1965, the following 
candidates were selected for advanced training in 
FY 1966. 

The 28 Naval Dental School student officers were 
selected from 96 applicants. Seniority is the princi- 
pal consideration for this selection on the premise 
that one purpose of the Naval Dental School is to 
bring the most recent advances in dentistry to the 



knowledge of dental officers at an appropriate inter- 
val in a Navy career. Of those 28, approximately 14 
will take the course in General Dentistry, and the 
others will major in one of the clinical specialities. 
Those who intend to pursue further specialty train- 
ing may enroll in the graduate program; others may 
enroll as postgraduate students. The graduate stu- 
dents will compete academically in the Naval Dental 
School off-campus graduate program of Georgetown 
University Dental School. 



U.S. NAVY MEDICAL NEWS LETTER 



17 



All dental officers are reminded that completion 
of an NDS course is not an essential in a career pat- 
tern. Selection Boards consider each officer's entire 
record. The vigorous individuals with consistently 
excellent records are selected for advancement in 
rank. Having completed the NDS graduate or post- 
graduate course is not necessary. 

Another subject which is often misunderstood is 
the fact that a graduate or postgraduate NDS course 
is one of three prerequisites for eligibility for fur- 
ther specialty training, either toward Board qualifica- 
tion or toward the basic sciences for research. Those 
three alternative prerequisites are the NDS course, 



a M.S. degree or a Naval Dental Corps Postdoctoral 
Fellowship. 

The records achieved in these prerequisites are 
used as a screening device to identify those dental 
officer graduate training applicants who have proven 
outstanding potential for graduate level study. 

Next year's meeting of the Dental Training Com- 
mittee will be held in early January rather than 
March. A forthcoming change in the BUMEDINST 
1520.2 (series) and MANMED will announce this 
earlier date and a deadline of 1 November 1965 for 
the submission of all applications. 



GRADUATE AND POSTGRADUATE COURSES (28) 



CDR B. F. Kresl, DC USN 
CDR H. D. Tow, Jr., DC USN 
CDR W. P. Kelly, DC USN 
CDR J. R. Bohacek, DC USN 
CDR R. H. Orrahood, DC USN 
LCDR A. F. Reid, DC USN 
LCDR R. E. Shirley, DC USN 
LCDR D. E. Hayes, DC USN 
LCDR J. H. Charles, Jr., DC USN 
LCDR D. E. Barlow, DC USN 
LCDR D. N. Firtell, DC USN 
LCDR E. J. Collevacchio, DC USN 
LCDR Z. Kawashima, DC USN 
LCDR J. R. Russell, DC USN 



LCDR C. N. Clark, III, DC USN 
LCDR J. J. Lawrence, Jr., DC USN 
LCDR M. R. Wirthlin, DC USN 
LCDR D. D. Albers, DC USN 
LCDR D. E. Duncan, DC USN 
LCDR L. M. Muldrow, DC USN 
LCDR R. N. Dodds, DC USN 
LCDR W. A. Grimsley, Jr., DC USN 
LCDR E. J. Masser, DC USN 
LCDR D. M. Grove, DC USN 
LCDR L. E. Mark, DC USN 
LCDR N. D. Wilkie, DC USN 
LCDR R. E. Moore, DC USN 
LCDR J. S. Kitzmiller, DC USN 



ORAL SURGERY TRAINING (15) 



CDR E. C. Allen, DC USN 
CDR T. W. McKean, DC USN 
LCDR J. T. Anderson, DC USN 
LCDR J. D. Cagle, DC USN 
LCDR W. R. Martin, DC USN 
LCDR T. F. McCann, DC USN 
LCDR J. M. Wilson, DC USN 
LCDR R. D. Baker, DC USN 
LCDR O. V. Hall, DC USN 
LCDR E. G. Mainous, DC USN 
LCDR H. O. Scharpf, DC USN 
LCDR J. J. Verunac, DC USN 
LT E. B. Bass, DC USN 
LT H. C. Howarth, DC USN 
LT W. C. Johnston, DC USN 



Second Year Residency 
Second Year Residency 
Second Year Residency 
Second Year Residency 
Second Year Residency 
Second Year Residency 
Second Year Residency 
First Year Residency 
First Year Residency 
First Year Residency 
First Year Residency 
Postdoctoral Fellowship 
Postdoctoral Fellowship 
Postdoctoral Fellowship 
Postdoctoral Fellowship 



18 



U.S. NAVY MEDICAL NEWS LETTER 



PROSTHODONTIC TRAINING (9) 



LCDR K. E. Brown, DC USN 
LCDR J. W. Hays, DC USN 
LCDR J. E. Miller, DC USN 
LCDR V. A. Pinkley, DC USN 
LCDR J. F. Scott, DC USN 
LCDR R. R. Thomason, DC USN 
LCDR T. L. Whatley, DC USN 
LCDR J. H. Hegley, DC USN 
LCDR J. E. Hyde, DC USN 



Residency 

Residency 

Residency 

Residency 

Residency 

Residency 

Residency 

Postdoctoral Fellowship 

Postdoctoral Fellowship 



PERIODONTIC TRAINING (11) 



LCDR R, C. Edwards, DC USN 
LCDR E. J. Heinkel, DC USN 
LCDR C. J. McLeod, DC USN 
LT S. V. Holroyd, DC USN 
LCDR W. J. Gorman, DC USN 
LCDR G. W. Rice, DC USN 
LCDR T. A. Bodine, DC USN 
LCDR R. J. Chutter, DC USN 
LCDR E. E. Little, DC USN 
LT J. E. Groat, DC USN 
LT P. W. O'Shields, DC USN 



Long Course Civilian Institution 
Long Course Civilian Institution 
Long Course Civilian Institution 
Long Course Civilian Institution 
Residency 
Residency 

Postdoctoral Fellowship 
Postdoctoral Fellowship 
Postdoctoral Fellowship 
Postdoctoral Fellowship 
Postdoctoral Fellowship 



ENDODONTIC TRAINING (5) 



CDR R. W, Mendel, DC USN 
LCDR H. Clarke, DC USN 
LCDR M. S. Davis, DC USN 
LCDR J. I. Tenca, DC USN 
LCDR J. H. Burke, DC USN 



Residency 
Residency 
Residency 
Residency 
Postdoctoral Fellowship 



OPERATIVE DENTISTRY TRAINING ( 1 ) 
LCDR C. J. Schultz, DC USN Long Course Civilian Institution 

ORAL MEDICINE TRAINING (1) 
LCDR P. S. Coombs, DC USN Residency 

DENTAL SCIENCE AND RESEARCH (2) 



LT A. B. Luke, DC USN 
LT P. B. Carroll, DC USN 



Postdoctoral Fellowship 
Postdoctoral Fellowship 



Dental Officer Presentations. CAPT L. A. Benson, 
DC USN, 2nd Dental Company, 2nd Marine Divi- 
sion, FMF, Camp Lejeune, North Carolina, pre- 
sented a lecture entitled, "The Current Status of 
Gingivectomy in Periodontal Therapy," before the 
Southeastern Periodontal Study Club of North Caro- 
lina on 17 February 1965. 

CAPT Gordon H. Rovelstad, DC USN, U.S. 
Naval Dental School, Bethesda, Maryland, presented 



a lecture entitled, "Current Concepts of Preventive 
Dentistry," before the Kanawha Valley Dental So- 
ciety on 6 April 1965 in Charleston, West Virginia. 

CAPT Frank J. Kratochvil, DC USN, U.S. Naval 
Dental School, Bethesda, Maryland, presented a lec- 
ture entitled, "Removable Partial Dentures," before 
the Philadelphia County Dental Society on 21 April 
1965 in Philadelphia, Pennsylvania. 

CAPT James B. Lepley, DC USN, U.S. Naval 



U.S. NAVY MEDICAL NEWS LETTER 



19 



Dental School, Bethesda, Maryland, presented a lec- 
ture entitled, "Post-surgical Prostheses," before the 
School of Dentistry, Ohio State University on 15 
April 1965 in Columbus, Ohio. 

CDR George H. Green, DC USN, U.S. Naval Den- 
tal School, Bethesda, Maryland, presented a paper 
entitled, "Oral Lymphomas," before the American 
Academy of Oral Pathology during the annual meet- 
ing 31 March-April 1965 in Las Vegas, Nevada. 

Montgomery-Bucks Dental Society Meets. CAPT 
William E. Crolius, Dental Officer of Naval Air Sta- 
tion, Willow Grove, Pa., was host at a dinner and 
professional meeting, of the Montgomery-Bucks 
Dental Society of Pa., on 25 January 1965. 

A total of 170 civilian dentists from nearby com- 
munities, as well as dental officers from Navy, Army 
and Air Force activities, in the Philadelphia area, 
were in attendance. 

CAPT Richard T. Blackwell, DC USN, a mem- 
ber of the teaching staff, at the U.S. Naval Dental 
School, National Naval Medical Center, Bethesda, 
Md., spoke on the "Practical Approach to Daily 
Operative Procedures." 

Retirement of Officers During the 3rd Quarter FY 
1965. The following officers were placed on the re- 
tired list during the 3rd quarter FY 1965: 

CAPT Bruce K. Defibre, USN 

CAPT Ralph B. Haynes, USN 

CAPT Joseph R. Horn, USN 

CAPT August Bartelle, USN 

CDR Charles W. Stevens, USNR 

Procedure for Addressing Official Correspondence. 
The following quote from Navy Regulations is 
printed as a reminder of the procedure for addressing 



official correspondence. An increasing volume of 
improperly directed mail has stimulated this release. 
To date no embarrassing situations have developed, 
and it is hoped this will correct the practice and pre- 
vent any problems. 

U.S. Navy Regulations 

1607. Addressees. 

1 . Official correspondence intended for the incum- 
bent of an office and pertaining to that office shall be 
addressed to him by title and not by name. 

2. Official correspondence intended for the Navy 
Department shall be addressed to the Chief of the 
bureau or office having control of the subject matter. 

3. Official correspondence intended for a com- 
mand or activity shall be addressed to the command- 
ing officer or officer in charge, as the case may be. 
This paragraph shall not be construed to prevent the 
direct exchange, between subordinates with a com- 
mand or activity, of memoranda, reports, and similar 
correspondence required in the performance of their 
duties. 

4. Except in the case of official correspondence 
intended for ships, the address may be followed by 
the title or the code designation of the office having 
immediate responsibility for the subject mattetr. 

5. Official correspondence erroneously addressed 
shall be forwarded by the recipient to the proper ad- 
dressee if known, and notice of such action shall be 
forwarded by the recipient to the proper addressee if 
known, and notice of such action shall be sent to the 
originator and to the activity from which received. 
If the proper addressee is unknown, the correspon- 
dence shall be returned to the originator. 



AVIATION MEDICINE SECTION 

NEW DEVELOPMENTS IN NAVAL AVIATION SEA SURVIVAL EQUIPMENT 

CAPT Roland A. Bosee, MSC USN, Bureau of Medicine and Surgery and Bureau 
of Naval Weapons. 



In 1946, Naval Aviation efforts were directed to- 
ward low temperature protective clothing for pilots 
and crewmen which eventually led to the constant 
wear MK-5 anti-exposure suit, the quick-donning 
suit and most recently the wet suit for helicopter 
rescue crewmen. These clothing items, it is em- 



phasized, provide only short term (measured in 
hours) low temperature protection. Elsewhere, 
efforts in the Naval Aviation area to provide long 
term, low temperature survival potential in the life 
raft area were minimal. 

In 1962, the Bureau of Naval Weapons assigned 



20 



U.S. NAVY MEDICAL NEWS LETTER 



to the Aerospace Crew Equipment Laboratory the 
responsibility as lead laboratory for the development 
of sea-survival equipment, including the life rafts and 
life preservers. Since that time, new efforts were 
directed toward the following objectives: 

a. providing long term, low temperature sur- 
vival potential for the pararaft and multi-place rafts, 
and 

b. providing life preservers with flotation and 
dry wear qualities superior to present designs. 

The following is a report on the current status of 
equipment developments which are related to these 
two goals. 

1 . One-Man Raft with Insulating Canopy — There 
has been no significant change in the one-man raft 
since World War II, primarily because the aircraft 
seats where they are stowed set a premium on space 
available for survival equipment and proposed im- 
provements increased the raft cube beyond allowable 
limits. In general, the cubage limits available for 
one-man rafts have been established at 7 3 A x 
1514 x 3 inches (354 cu. in.). However, aided by 
recent new lightweight fabric developments, the 
ACEL has developed an improved one-man raft 
within the parameters of the package size of the cur- 
rent PK-2 and MB-4 rafts with the following addi- 
tional features: 

a. Double-Layer (orally inflatable) Canopy — 
configured to accommodate a pressure suited sur- 
vivor. Insulation is provided by the dead air space 
between the canopy layers. 

b. Increased Raft Length and Width — 7 inches 
longer and 7 inches wider inboard than the current 
PK-2 and MB-4 for added comfort. 

c. Two Ballast Buckets — plus floor with lower 
center of gravity for increased stability in a sea-way. 

d. Inflatable Seat — to reduce low temperature 
heat loss and discomfort in the buttocks area. 

Laboratory test and evaluation of the new model 
raft have not been completed. No data on the low 
temperature protection effectiveness of the raft are 
available at this time, but it is clear that the new raft 
offers more low temperature protection than the cur- 
rent raft — which offers little or none at all. Require- 
ments are being developed, and it is planned to pur- 
chase 100 rafts for fleet evaluation. Since the raft is 
capable of installation in the helicopter back-pack 
raft container, it is further planned to deliver some 
of these rafts to HU-1, HU-2 and HS squadrons 
for evaluation. It is anticipated that the rafts will 
be delivered to the field by June 1965. 



2. Multi-Place Life Rafts — This newly developed 
25-person capacity life raft is directly aimed at low- 
temperature protection for survivors and has a num- 
ber of interesting new features such as : 

a. Self-Erecting Canopy — Canopy erects when 
raft inflates. 

b. Double Layer Insulating Canopy — Insulation 
is provided by dead air space between the canopy 
layers as in the Bureau of Ships and British ship- 
board rafts. 

c. Increased Capacity—Has a 25-person capac- 
ity but occupies the same package volume as the cur- 
rent 20-man raft. 

d. Insulated (inflatable) Seats — To prevent heat 
loss and discomfort in buttocks area in cold waters. 

e. Ballast Buckets — For improved raft stability. 

f. Detection Light — Located on top of canopy, 
lights up when raft is inflated. 

g. Boarding Lights — Small salt-water activated 
lights at boarding stations. 

h. Inboard Stowed Survival Equipment — For 
ready access. 

Consideration is also being given to inclusion of 
an automatic signal beacon. This raft has just been 
delivered by the contractor for laboratory evaluation. 
A contract for similar changes to the MK-7 raft has 
been recently awarded. Ultimate aim is to provide 
automatically erectible, insulating type canopies on 
all multi-place rafts. 

3. Cool-Gas Generation for Life Raft Inflation — 
Two development efforts are under contract in this 
area for application to one-man rafts in lieu of the 
current C0 2 system. Successful application would 
permit rapid inflation in all temperature environ- 
ments and eliminate the possibility of raft fabric 
cold cracking (and subsequent leakage) in low tem- 
perature inflations. 

4. Heating Equipment for Survival Application — 
The Bureau of Naval Weapons is also sponsoring 
the first phase of a development program for a hy- 
drogen-generator, catalytic heater that could possibly 
be incorporated within an aviator's clothing and sur- 
vival gear with its heat output being applied directly 
to the body surface and the floor of the life raft. In 
concept, the proposed system reacts solid sodium 
aluminum hydride with sea water to generate hy- 
drogen, mixes the hydrogen with air in the proper 
dilute non-explosive ratio (by aspiration or pumping 
using hydrogen pressure) and employs low tem- 
perature catalytic combustion in beds located within 
or at the entrance to clothing ensembles at the body 



U.S. NAVY MEDICAL NEWS LETTER 



21 



extremities and in the life raft. Inflation gas for the 
raft would be provided by the hydrogen-air mixture. 

5. A New Life Preserver Concept — The current 
Naval Aviation life preservers, the MK— 2, MK-3, 
and the MK— 4, are worn outside of various flight 
clothing and are unsatisfactory in varying degrees 
with respect to their bulk, dry wear and flotation 
characteristics. A new life preserver system (desig- 
nated the MK-5) has been found capable of instal- 
lation inside various existing and proposed flight 
clothing which reduces or elminates bulk from 
frontal, underarm and back areas of the aviator to 
provide improved dry-wear characteristics. The 
MK— 5 preserver unit is specifically designed to pro- 
vide flotation characteristics superior to those of the 
three current Naval Air preserver types. This new 
development includes: 

a. Life Preserver Element — The basic life pre- 
server element is constructed of coated fabric, pro- 
vides approximately 55 pounds of buoyancy at 70°F 
at an internal pressure of 1.75 psig. Two dual pull 
C0 2 cylinder holders, four 12-gram capacity C0 2 
cylinders, two manifolds and two oral inflation valves 
comprise the inflation system. The preserver is com- 
partmented with the C0 2 charge inflating the collar 
section and the other charge inflating the body lobes. 
This permits inflating the preserver body lobes dur- 
ing parachute descent for immediate buoyancy on 
water landing with collar inflation after release of 
parachute. Both compartments, of course, can be 
inflated simultaneously if desired by merely tugging 
both C0 2 toggles at the same time. After boarding 
the raft, the collar section can be deflated via an oral 
valve if desired for greater comfort. The preserver 
is folded in and securely anchored to the particular 
clothing unit, but is removable. No size grading of 
the preserver is needed. On actuation of the C0 2 
inflation system, the buoyancy element "pops out" 
of the frontal and collar areas of the suit. 

6. Summer Flight Coverall with Internal Harness 
and Integrated Flotation — Intended Use — For ejec- 
tion seat type aircraft (non-pressure suit flights) 
summer flight clothing configuration. 

Purpose- — To replace the current three-piece com- 
bination of summer flying coverall, the integrated 
harness suit and the MK-3C life preserver with a 
single donning unit so as to increase pilot comfort 
and provide superior flotation characteristics. 

Description — Summer flying coverall of flame re- 
sistant fabric (HT-1 ) incorporates a parachute har- 
ness and integrated flotation unit into a single 
donning unit. 



Test Status — Sea tests by the ACEL, parachute 
jump tests by the Naval Aerospace Recovery Facil- 
ity, El Centro and comfort tests by Naval Air Test 
Center, Patuxent River were satisfactory. 

Development Status — Award of 257 units for field 
evaluation has been made for anticipated June 1965 
delivery. 

7. Summer Flight Suit with Integrated Flotation 
Intended Use — For use by pilots and crewmen of 

nonejection seat type aircraft. 

Purpose — To increase pilot dry wear comfort and 
to provide flotation that is superior to the current 
MK-2 life preserver. 

Description — This development consists of a sum- 
mer flight suit with flotation unit inside the frontal 
and collar areas. 

Test Status — Laboratory models are being con- 
structed for comfort evaluation by the Naval Air 
Test Center, Patuxent River and jump testing with 
back and seat type parachutes by the Naval Aero- 
space Recovery Facility, El Centro. 

Development Status — Purchase of a field evalua- 
tional quantity are anticipated during this fiscal year. 

8. Torso Restraint Flotation Assembly 
Intended Use — For use over the MK— 5 anti-ex- 
posure suit in ejection seat type aircraft (non-pres- 
sure suit flights). 

Purpose — To replace the MK— 3C life preserver 
which has unsatisfactory, dry wear characteristics. 

Descrpition — This development consists of a torso 
restraint garment with parachute harness sewn within 
the two layers of the garment combined with the in- 
ternally integrated flotation system. 

Test Status — Sea tests of prototype by the ACEL 
were successful, comfort tests by the Naval Air Test 
Center, Patuxent River were also successful and a 
model is scheduled for delivery to the Naval Aero- 
space Recovery Facility, El Centro for jump testing. 

Development Status — A contract has been 
awarded for 100 units for field evaluation with antic- 
ipated delivery in March 1965. 

9. Helicopter Survival Garment (Hanson Vest) 
Intended Use — For use by helicopter pilots and 

crewmen and most particularly for use by Helicopter 
Anti-Submarine Squadrons over anti-exposure or 
summer flight suits. 

Purpose — To replace the two-piece combination 
of MK-2 life vest and back-pack raft with a single 
donning torso unit which combines preserver and 



22 



U.S. NAVY MEDICAL NEWS LETTER 



raft to provide greater pilot comfort, superior pre- 
server flotation and survival equipment stowage. 

Description — This development consists of a 
single donning torso unit with the flotation element 
integrated into the frontal area of the garment and 
a raft in the back of the garment. Pockets are pro- 
vided in the front for installation of survival equip- 
ment. 

Test Status — Sea tests were satisfactory. 

Development Status — A contract has been 
awarded for 70 units for field evaluation with antic- 
ipated delivery in January 1965. 



10. Helicopter Survival Flight Coverall (Proposed) 

Intended Use — For helicopter pilots and crewmen 
and most particularly for use by Helicopter Anti- 
submarine Squadrons in warm climates. 

Description — This garment is similar to the sum- 
mer flight suit with integrated flotation described in 
7 above except that a removable backpack raft con- 
tainer is attached to the back area of the garment by 
life-a-dot fasteners. 

Test Status — Not tested. 

Development Status — One prototype prepared. 



1. Package Size 


73/4" x 15 Va" x 3' 


2. Weight 


8 pounds 


3. Inflated Dimension 


Length 




Inboard 4' 7" 




Outboard 5' 914 



4. Canopy 

5. Inflatable Seat 

6. Floor 

7. Ballast Buckets 

8. Tube Diameters 

9. Inflation System 



10. 
11. 



Sea Anchor 
Materials 



DATA ON AEROSPACE CREW EQUIPMENT LABORATORY DESIGN 
PARARAFT WITH LOW TEMPERATURE PROTECTION 

Current PK-2 and 
New Design Rraft MB-4 Rajt 

x 3" (354 cu. in.) 1W x \5Va" x 3" (354 

cu. in.) 

7 pounds 

4'0" 
5'0" 

I51/2" 
15V2" 
IS 1 /*" 

Single layer, non-insulat- 
ing, snap fastener closure 

Not present 
Conventional 

Not present 

Varies from 10" D. at 
bow to 6 Va" at stern 

Provides approximately 
0.75 psi gas pressure at 
70°F. 

Conventional 



Width (INBOARD) 
Bow Section 22 V4" 
Amidships 19 W 
Stern Section lS 1 ^" 

Double layer, tufted, orally inflatable for insulation, 
Velcro closure, configured to accommodate pressure 
suited survivors 

Tufted, orally inflatable 

Constructed so as to provide lower center of gravity 
for seated occupant ( 1 ) 

Two provided on floor of bow 

Varies 8 WD. at bow to 5%" at stern 

Standard CO, system (0.50 pound charge) provides 
approximately 1.5 psi gas pressure at 70°F. 

Conventional 

Buoyancy Tubes 

5.0 oz. neoprene-coated nylon 

Floor 

5.0 oz. neoprene-coated nylon 
Canopy 

2.3 oz. polyurethane-coated nylon 



11.2 oz. 2 ply, 
coated cotton 



rubber- 



7 oz. rubber-coated nylon 
3 oz. rubber-coated nylon 



NOTES 



(1) A system to permit bail-out of water after canopy closure Is being developed. 

(2) A larger sea anchor, semi-hemispherical shape, is proposed if future tests indicate need for reduced rate of dntt. 



U.S. NAVY MEDICAL NEWS LETTER 



23 



FLIGHT PHYSIOLOGY NOTES 



TO BE OR NOT TO BE 
AWARE— ALERT— ALIVE 

Aviation Physiology Training Unit, US NAS North 
Island, Jan 8, 1965. 

Consciousness is generally defined as an aware- 
ness, especially of something within oneself; state or 
fact of being conscious in regard to something; the 
upper level of mental life. Medically it is defined as 
the responsiveness of the mind to the impressions 
made by the senses or the critical reactivity of the 
mind to events in the environment. 

Most of us are apt to take consciousness for 
granted, but actually of all the physiological proc- 
esses it is in many respects the most tenous since it 
may have many levels or states, which on their 
fringes blend imperceptively with one another. Pre- 
occupation, fatigue, apprehension, pain, temperature, 
"G" forces, hypoxia, etc; in fact there are few if 
any "internal" or "external" factors which can not 
either independently or in consort influence what 
might be termed "functional consciousness." 

Functional consciousness may be defined as that 
part of the whole consciousness that is necessary 
for optimal performance of a given function or task 
and will vary directly with the complexity and/or 
sophistication of the function. The availability of a 
given functional consciousness will in turn be de- 
pendent upon the level of whole consciousness and 
on the auxiliary demands then placed on this level. 

For example if we assign the figure of 100 to the 
whole consciousness and if the optimal functional 
consciousness for driving a car is 75 a reserve con- 
sciousness of 25 is available. If then the car radio 
is turned on and quiet music (not the Beatles) is 
listened to, this auxiliary demand will drain off an 
additional 15 leaving a reserve consciousness of 10. 
If on the other hand the car radio is turned on to an 
exciting football game this auxiliary demand might 
well drain off 40 thereby using up all of the reserve 
consciousness level to below the optimum. It also 
follows that any decrease in whole consciousness 
could, and nearly always does, adversely affect func- 
tional consciousness since reserve consciousness 
would be lessened and any auxiliary drain would 
most likely result in a reduced functional conscious- 
ness. 

The over- all concept of the various states of con- 
sciousness is only of passing interest to man in his 
everyday life since he equates only consciousness and 



unconsciousness. Admittedly, even in everyday life 
an unexplained period of time out of one's con- 
sciousness can be rather perplexing, if not a shaking 
event, but it assumes monumental proportions if it 
occurs while in control of an aircraft. 

Since the very nature of the profession of flying 
exposes one to biophysical conditions which in- 
creases the potential for dramatic changes in the 
whole and in functional levels of consciousness it is 
worthwhile to examine a few of the factors. 

That hypoxia can cause a lowering of the level of 
consciousness is axiomatic. Brain tissue, of all of the 
tissues that make up the body, is singularly the most 
sensitive to a decrease in oxygen availability. The 
normal blood flow required by the functioning brain 
is ten times that of the remainder of the body on a 
weight for weight basis and the normal "oxygen 
debt" of the brain only suffices for approximately six 
seconds. It is therefore apparent that the delivery 
of an adequate amount of oxygen and its continuous 
utilization at the tissue level is a fundamental param- 
eter of brain function. 

The resulting lowering of the level of conscious- 
ness that results from a reduction of oxygen availa- 
bility to brain tissue as described by the signs and 
symptoms of hypoxia are well known to those in 
aviation. But just as a reminder it might be well to 
quote in part from G. Tissander's dramatic descrip- 
tion of balloon assent to 25,000 ft. in 1875 which 
proved fatal to both of his companions. 

"But soon I was keeping absolutely motionless, 
without suspection that perhaps I had lost use of my 
movements. Toward 7,500m. (24,606 ft.) the 
numbness one experiences is extraordinary. The 
body and the mind weaken little by little, gradually, 
unconsciously, without one's knowledge. One does 
not suffer at all; on the contrary, one experiences 
inner joy, as if it were an effect of the inundating 
flood of light. One becomes indifferent; one no 
longer thinks of the perilous situation; one rises and 
is happy to rise. Vertigo of lofty regions is not a 
vain word. But as far as I can judge, this vertigo 
appears at the last moment. It immediately precedes 
annihilation, sudden unexpected, irresistible." 

Hypoxia can indirectly play a role in relation to 
consciousness by producing a sense of air hunger 
with an associated response of an increase in rate 
and depth or respiration. This varying degree of 
hyperventilation is an attempt by the body to com- 
pensate for the hypoxia by increasing the lungs effec- 



24 



U.S. NAVY MEDICAL NEWS LETTER 



tiveness and thereby the amount of oxygen carried 
by the blood. In mild conditions of hypoxia this 
compensating system is fairly effective unfortunately 
this procedure is in part negated by the fact that 
hyperventilation also reduces the carbon dioxide 
level of the body, which in turn may interfere with 
the ability of the tissues to utilize the oxygen. A 
final comment regarding hypoxia is the paradoxical 
response, a slowing of the pulse, fall in blood pres- 
sure and inhibition of respiration. The prevention 
of hypoxia by a thorough understanding of the prob- 
lem and of the systems used in aviation to protect 
against hypoxia, is in the final analysis, the best 
means to avoid its pitfalls. 

The other chemical substrate on which the brain 
is dependent for optimal function is blood sugar. 
There is abundant evidence that whole consciousness 
and functional consciousness of an individual varies 
directly with the blood sugar level. It has been re- 
ported that six out of nine aircraft incidents and/or 
accidents occurred some hours after the last meal, 
either late morning or late afternoon and that it is 
common to find in these cases, a history of missed or 
deficient meals. Inadequate diet, and its effect of 
lowering blood sugar levels, produces significant in- 
creases in neuromuscular tremor, irritability, reaction 
time, sweating and confusion coupled with dimin- 
ished maximum work output and a general lowering 
of whole consciousness. This lowering of whole con- 
sciousness and increased auxiliary drains (tremor, 
sweating, confusion) significantly compromises func- 
tional consciousness. 

Hyperventilation per se is another factor which 
can occur during flight and which is a potent influ- 
ence on consciousness. Its effect on consciousness 
is mediated through its influence on the blood flow 
to the brain and through its effect of shifting the 
blood acid-base balance to the alkaline side, which in 
turn interferes with the red blood cells effectiveness, 
in delivering their oxygen to the brain cells. The 
reduction of blood flow to the brain due to hyper- 
ventilation involves two mechanisms, vasoconstric- 
tion of the cerebral vessels and the concurrent 
vasodilation and increased pooling of blood in the 
muscles. The effect of this combination can, either/ 
or; dramatically lower the level of whole conscious- 
ness; produce unconsciousness; lower functional con- 
sciousness by increased susceptibility to side drain- 
off factors such as apprehension, tremor, etc. 

U.S. NAVY MEDICAL NEWS LETTER 



Positive pressure breathing affects blood flow to 
the brain and therefore consciousness by its effect of 
damming back of blood in the chest and thus de- 
creasing the filling pressure of the heart. 

It is well known that strong positive G can pro- 
duce profound alterations in the blood flow to the 
brain, but it should be noted that relatively small 
increases in positive G can likewise produce pro- 
found alterations when coupled with other mechan- 
isms that act similarly. 

These and a whole host of other factors such as 
vertigo, hangover, worry, personal equipment, cock- 
pit contamination, etc. can, either independently or 
in consort influence the whole or functional levels of 
consciousness. 

Be conscious of these factors and do not let them 
gang up on you to produce permanent unconscious- 
ness. 

MK5/5A ANTI IMMERSION SUITS 

There has been some confusion as to whether or 
not the inner liner should be worn and if waffle 
weave underwear can be substituted for the inner 
liner. The answer is that the inner "insulation- ven- 
tilation" liner must be worn in order for the MK5/ 
5A Anti immersion assembly to be effective. It is 
this inner garment that provides the thermal barrier 
and the ventilation system to the suit. The waffle 
weave underwear is not a satisfactory substitute since 
it does not provide an adequate thermal barrier nor 
a ventilation distributing system. BUWEPS clothing 
and Survival Equipment Bulletin No. 60-61 states 
in part "To receive full benefit of its (MK5/5A) 
design it is important that personnel wear the 
MK5/5A coverall assembly exactly as described 
here-in." 

The old MK5 used the Z-4 Anti-G suit listed in 
the section "H" allowance, this has a screw type 
fitting that mated with the round port of the MK5 
suit. The MK5A has a square port and is com- 
patible with the MK-2A or the full pressure suit 
MK-2 Anti-G suit. This MK-2A Anti-G suit will 
eventually be the only anti-G suit in the system and 
will be used with the full pressure suit, MK5A Anti- 
exposure suit and the summer flight suit. 

The following are some stock numbers that might 
be helpful: MK-5A Anti-Exposure Suit Stock # 
of part: 

25 



Wrist seal: 



MK-ZA Anti-GSuit: 



Airport for MK-ZA (Green) : 
Airport for Vent Garment (Red) : 
Adapter for MK-ZA Anti-G 
Cover plate for Airport: 
Socks for MK-5A: 

Neck seal for MK-5A: 

Gloves, Anti-Exposure insulated: 

Tape, Rubber W Type 3: 

Tape, Coated cloth, 1" Type 3: 

Cloth, Rubber Coated Stretch Nylon, 50" Type 1 : 

Adapter for MK-5 Liner for MK-5A Outer Suit: 



Small: 
Medium: 
Large: 

Large long: 
Large short: 

Small long: 
Small short: 



Medium: 
Large: 



Size 8 

Size 9 

Size 10 



RM 8475-226-5703-IF50 
RM 8475-226-5703-IF50 
RM 8475-226-5703-IF50 

RD 8475-964-27 13-IF50 
RD 8475-964-2714-IF50 
RD 8475-964-2715-IF50 
RD 8475-964-2712-IF50 

RM 8475-019-3884-IF50 

RM 8475-686-1737-IF50 

RM 8475-01 6^1522-IF50 

RM 8475-019-3885-IF50 

RM 8475-862-3340-IF50 
RM 8475-8 62-8262-IF50 

RM 8475-027-0261-IF50 

RM 8475-862-3337-IF50 
RM 8475-862-3338-IF50 
RM 8475-862-3339-IF50 

RM 9320-045-8113-L980 

RM 9320-078-8624-L980 

RM 9320-045-81 12-L980 

ACEL 64A102C1 



Flll-B (TFX) ESCAPE AND SURVIVAL 
SYSTEM 

For the first time in operational aircraft, the 
escape system will be an integral part of the cockpit, 
a cockpit pod. This is the description of the emer- 
gency escape system for the Navy's Fll 1-B (TFX) , 

Currently, emergency escape from military air- 
craft is usually accomplished by "over-the-side" 
bailout or by use of an ejection seat. Wind blast, 
tumbling, flailing, contact with aircraft structures, 
entanglement with parachute lines, low temperature, 
high surface winds, inability to release the personnel 
parachute, inability to climb aboard a life raft, and 
loss of survival gear have been factors exacting a 
high toll in personal injuries and loss of life. The 
fifteenth Flll-B scheduled for delivery to the Navy 
in early 1966 will have the first Escape Pod. Earlier 
aircraft deliveries will incorporate a conventional 
ejection seat escape; however, the first fourteen air- 
craft will be fabricated in a manner to permit retro- 
fit of the pod system. The functional design and 
scheduled performance of the pod system are such 
to preclude the crew members from exposure to the 



previously mentioned hazards in the event escape 
from the aircraft is required. 

When the escape sequence of the new system is 
initiated, the cockpit section is severed instantane- 
ously from the aircraft. The metal skin and other 
structures are instantly cut just fore and aft of the 
cockpit bulkheads. If required, the cockpit segment 
will remain pressurized just as if it were still a part 
of the aircraft. Subsequent to cutting, a rocket motor 
will lift the cockpit section to an altitude compatible 
with parachute deployment. The system is designed 
to function under conditions of zero speed and zero 
altitude. The pod thus formed will lower the airman 
to earth and will remain a survival vehicle for a 
touchdown on land or as a boat for landing at sea. 
All emergency and survival items are carefully 
stowed in the pod and within easy reach. 

To make possible this newly designed escape sys- 
tem, the single, most important technical break- 
through was the Navy-pioneered flexible, linear- 
shaped charge (FLSC) and mild detonating cord 
(MDC). The FLSC is a V-shaped, high-explosive, 
encased in a lead sheath. The Shape Charge is ap- 



26 



U.S. NAVY MEDICAL NEWS LETTER 



proximately Vs inch in thickness and is attached to 
the aircraft structure by means of a fiberglass shield. 
Between the Shape Charge and the shield, a high 
temperature foam is packed to provide ignition un- 
der all conditions, even under water. The V-shaped 
case directs the blast out the open side of the "V" 
as a cutting wave. It cuts smoothly and extremely 
rapid, so fast in fact, that the entire cockpit section 
is cut from the remaining fuselage in less the ten 
milliseconds. These pyrotechnic devices are per- 
cussion-actuated, and are insensitive to radar, high 
voltage, and radio frequency. 

Even at sea level and zero speed, the pod is sepa- 
rated to an altitude that will provide 175 foot de- 
scent at a rate of 30 feet per second after the de- 
ployment of a 70 foot diameter parachute. In the 
event that the ejection materializes above 15,000 
feet, a barostat delays the parachute opening until a 
15,000 foot altitude is reached. Impact bags stowed 
in the pod are automatically deployed and inflated 
below the pod center of gravity. These collapse at 
touchdown, and thus attenuate some energy. Special 
flotation and self-righting bags can be deployed man- 
ually or automatically to provide buoyancy in the 
event there are leaks in the normally air-tight pod 
which have resulted from combat damage. 

Optimum utilization of the escape pod concept 
will reduce the weight and bulk of the personally 



worn survival equipment to that of an anti-g suit, 
gloves, protective helmet, and the back-up oxygen 
mask. The lightly clad crewman in the pod is a far 
cry from the currently worn exposure suit, Mae 
West, flashlight, flares, radio, shark chaser, para- 
chute, sea survival kit, 38-caliber pistol, and bulky 
full pressure suit. For the first time, the crew will 
be able to concentrate on its mission under condi- 
tions of maximum comfort and efficiency. No longer 
will there be a necessity, self-consciously or other- 
wise, to be concerned with such details associated 
with emergency escape as "position, jettison canopy 
if time permits, pull face curtain, close exposure suit, 
concern with cold water, release of parachute risers, 
climbing to a life raft." All of the escape sequences 
and requirements will be automatically sequenced 
once the emergency sequence has been initiated. 

The Bureau of Medicine and Surgery has been a 
prime consultant through its areomedical liaison in 
the establishment of this improved egress system. 
At the request of the Bureau of Medicine and Sur- 
gery, the Commanding Officer and Director of the 
Naval Training Device Center is engaged in a pilot 
study which will result in the production of a capsular 
training device. This device will be placed at 
selected air stations and operated by the Aviation 
Physiology Training Units prior to Fleet introduction 
of theFlll-B. 

— Aviation Medicine Sec, BTJMED 



MISCELLANY 



LCDR TOBER NAMED FIRST RECIPIENT OF 

APHA MILITARY SECTION LITERARY 

AWARD 

LCDR Theodore W. Tober, a pharmacist on the 
staff of the U.S. Naval Hospital, Portsmouth, Va. 
has been named first recipient of the recently estab- 
ished American Pharmaceutical Association Military 
Section Literary Award. 

The award, consisting of a $500 honorarium and 
plaque, will be presented at the first luncheon session 
of the Military Section on March 29, during the 
APhA annual meeting in Detroit. 

The 1965 award, made possible by a grant from 
Eli Lilly and Company, is for Commander Tober's 
paper "Applications of Data Processing to Hospital 



Pharmacy," published in the March, 1964, Ameri- 
can Journal of Hospital Pharmacy. The paper was 
written by Commander Tober when he was serving 
as Chief of Pharmacy Service, U.S. Naval Hospital, 
Naval Air Station, lacksonville, Fla. 

The Military Section Literary Award Selection 
Committee consists of John M. Gooch, Chairman; 
Mrs. Gloria Francke; Graver C. Bowles, Jr.; W. 
Paul Briggs and Noel Foss. The award is presented 
annually in recognition of the best original contribu- 
tion to the pharmaceutical literature during the 
calendar year preceding the annual meeting of the 
Military Section by a member of APhA employed by 
the federal government. Publications must have a 
significant relation to pharmaceutical practice, edu- 
cation, administration, pharmaceutical research. 



U.S. NAVY MEDICAL NEWS LETTER 



27 



pharmaceutical law or legislation, or professional 

regulation as it is related to the federal government. 

— From: APhA News, February 10, 1965. 

CAUTIONS REGARDING THE USE OF 

POTASSIUM CHLORIDE IN ENTERIC 

COATED TABLETS 

Required changes in labeling of thiazide diuretics 
and thiazide diuretics in combination with enteric- 
coated potassium chloride will soon be announced, 
said Commissioner George P. Larrick, Food and 
Drug Administration, Department of Health, Edu- 
cation, and Welfare. 

Commissioner Larrick also said that enteric- 
coated potassium tablets (FSN 6505-299-8761) will 
be restricted to the prescription list. He said the 
actions will be based on data from an extensive 
clinical survey and laboratory studies on animals re- 
ported to FDA January 6, 1965. These data, he 
said, were published in the February 22 issue of the 
Journal of the American Medical Association. They 
indicate a relationship between localized high con- 
centration of potassium and ulcerative-obstructive 
lesions of the small intestine, although the incidence 
is low and a casual relationship in man has not 
conclusively been established. 

FDA Medical Director, Joseph F. Sadusk, Jr., 
M. D., said that the thiazide products are often used 
to reduce edema. Because thiazide diuretics some- 
times cause a depletion of potassium in patients, 
physicians administering thiazide alone, he said, 
often supplement it with potassium tablets. Thiazide- 
potassium products, he added, contain potassium for 
the same reason. 

Dr. Sadusk said the revised labeling will recom- 
mend that physicians resort to natural food sources 
of potassium when possible to replenish the loss 
caused by thiazide diuretics. He added that coated 
potassium tablets should be used only when adequate 
dietary supplementation is not practical. He ex- 
plained " that potassium in foods disseminates 
throughout the intestine whereas a potassium tablet 
may settle in one place before dissolving and, being 
in high concentration, could cause a lesion. 

Dr. Sadusk said the new labeling will point out 
that these small bowel lesions have caused obstruc- 
tion, hemorrhage and perforation. The treatment is 
usually surgical. Some deaths have been reported. 
The labeling will warn physicians to administer 
coated potassium containing products only when in- 
dicated and that they should be discontinued should 



abdominal pain, distention, nausea or gastrointestinal 
bleeding occur. 

FDA said that following publication of two previ- 
ous reports in the medical literature which linked the 
thiazide-potassium diuretics to ulcers of the small 
intestine, the Agency on November 17, 1964, held a 
conference with the two major manufacturers of 
these products — Ciba Pharmaceutical Company and 
Merck, Sharp & Dohme. The two firms offered to 
expand a hospital survey of patients already in prog- 
ress to find cases of such ulcers and to see if they 
are related to the use of thiazide-potassium diuretics 
or to supplemental coated potassium tablets. The 
survey to date has covered 440 selected hospitals in 
the United States, Canada, South America, Europe, 
Africa, Australia and New Zealand. In addition, 
some cases have been reported directly to FDA. 

Relabeling of thiazide and of thiazide-potassium 
combinations to be announced in detail shortly will 
have industry-wide application, Dr. Sadusk said. 

— DHEW, Food and Drug Administration, 

Feb. 19, 1965. 

ISOMETRIC EXERCISES FOR THE 
UPPER-EXTREMITY STUMP 

CDR Marion D. Bates, MSC USN and LCDR 
Joseph C. Honet, MC USNR*. 

The importance of exercises designed to 
strengthen the stumps of amputees is well known. 
Many such programs have been proposed. 1 ^ 3 This 
report presents a method of strengthening the stump 
musculature in upper-extremity amputees, utilizing 
an isometric exercise technique. 

The only equipment used is an aluminum elevated 
platform with a foam rubber leatherette upholstered 
cover, 13 x 7 x 3 inches, commercially called a 
quadriceps rest. Other similar devices may be sub- 
stituted, such as a modified foot stool or canvas- 
covered sandbags. The exercises are performed on a 
firm surface, e.g., floor mat, padded plinth, or 
carpeted floor. Each exercise is performed ten times 
at least twice daily. Every muscular contraction is 
held for five seconds and followed by five seconds of 
complete relaxation. 

The positions used for muscular strengthening are 
adapted from Daniels, Williams, and Worthingham. 4 
The exercises may be adapted for the shoulder ab- 
ductor, flexor, extensor, rotator, and horizontal ab- 
ductor and adductor muscles, 

* Commander Bates . is Chief Physical Therapist, Physical Medicine 
Service, U.S. Naval Hospital, Oakland, California. Lieutenant 
Commander Honet is Chief, Physical Medicine Service, U.S. Naval 
Hospital, Oakland, California. 



28 



U.S. NAVY MEDICAL NEWS LETTER 



This method of strengthening the musculature of 
upper-extremity amputees by means of isometric ex- 
ercises has several apparent advantages. The exer- 
cises can be performed easily and simply with a 
minimum of equipment. Supervision can be pro- 
vided for several patients at one time, if necessary. 
The exercises can be learned readily by the patient 
and then can be performed independently at home. 
It should be stressed that initial instruction with ade- 
quate supervision is necessary before releasing the 
patient for home therapy, and periodic rechecks un- 
der supervision are advisable. 

REFERENCES 

1 ReiUy, G, V.: Preprosthetic Exercises for Upper Extremity Am- 
putees, Phys. Ther. Rev., 31: 183-188, May 1951. 

2. Jampol, Hyman: Physical Therapy Program for the Upper Ex- 
tremity Amputee, Phys. Ther. Rev., 32: 553-558, November 1952. 

3. Eisert, Otto, and Tester, O. W.: Dynamic Exercises for Lower 
Extremity Amputees, Arch. Phys. Med., 35: 695-704, November 
1954. 

4. Daniels, Lucille; Williams, Marian; and Worthingham, Catherine: 
Muscle Testing Techniques of Manual Examination. 2nd Edition, 
Philadelphia, W. B. Saunders Company, 1956, p. 176. 

A STUDY OF ALCOHOLICS 

Alcoholics, particularly those with the most severe 
forms of the disease, are increasing among State 
mental hospital admissions, according to Dr. Stanley 
F. Yolles, Director of the National Institute of Men- 
tal Health. 

A study by the Institute's Office of Biometry, 
Public Health Service, U.S. Department of Health, 
Education, and Welfare, reveals that one in seven 
newly admitted patients is an alcoholic, an 18 per- 
cent rise in 10 years. In 9 States, disorders asso- 
ciated with alcoholism lead all other diagnoses in 
mental hospital admissions. 

Recent figures analyzed by Ben Z. Locke, NIMH 
statistical show a startling rise in the number of 
alcoholics diagnosed with "chronic brain syndrome 
associated with alcoholism," the most severe and 
hopeless of the 3 classifications of the disease. Pa- 
tients in this group suffer permanent and irreversible 
destruction of the tissues of the brain. The damage 
probably results from metabolic or nutritional de- 
fects caused by prolonged use of alcohol. 

These alcoholics undergo severe personality 
changes, delirium, confusion, amnesia, confabula- 
tion, or talkativeness about things that never hap- 
pened, inflammation of the nerves, and pain in the 
arms and legs. The brain damage may be diagnosed 
by the electroencephalogram. 

More than half the alcoholics now in State mental 
hospitals suffer from this irreversible form of alco- 
holism — a 50 percent increase in this group in the 
past 10 years. This rise occurred during a period 
when the number of patients in mental hospitals has 



dropped. Patients in public mental hospitals in 1952 
totaled 531,981 in contrast to approximately 495,- 
000 today. Resident patient rates for these hospitals 
have dropped from 438 per 100,000 population in 
1952 to about 359 per 100,000 now. 

In contrast to the "chronic brain syndrome" pa- 
tients, the other two classifications of alcoholics, 
"acute brain syndrome associated with alcoholism," 
and "sociopathic personality disturbance, alcoholism 
addiction," have grown at a much slower rate. 

An analysis of one characteristic State, Ohio, fur- 
nishes this profile of the typical alcoholic admitted to 
a mental hospital: The odds are better than 4 to 1 
that he will be a male, probably separated or di- 
vorced with little or no elementary education. He is 
most likely to be admitted to the hospital for the 
first time, in his forties. 

The person least likely to become an alcoholic pa- 
tient, according to these statistics, is the married 
female with some college education, either under 35 
or over 54 years of age. Figures from other States 
show that the Ohio profile accurately represents the 
national picture. — DHEW, National Institute of 
Mental Health, March 4, 1965. 

AMERICAN BOARD OF OBSTETRICS AND 
GYNECOLOGY 

The next scheduled Part I (written) examination 
will be held at various examining centers in the 
United States, Canada, and military bases outside 
of the continental United States on Friday, July 2, 
1965, at 10:00 A.M. 

Applications received for the next Part II ex- 
amination to be given in Chicago, Illinois in April of 
1966 will be reviewed by the Credentials Commit- 
tee in September and notifications will be mailed to 
candidates on or about October the first. 

The 1965 Bulletin outlining current requirements 
should be available upon request about July the first. 
Application forms and Bulletins may be obtained by 
writing the Office of the Secretary. Applicants are 
urged to familiarize themselves with the current rules 
and regulations, particularly in view of the changes 
in application and examination schedules effective 
this year. 

Diplomates of this Board are requested to keep 
the office of the Secretary informed of their current 
address. 

Clyde L. Randall, M. D. 
Secretary and Treasurer 

American Board of Obstetrics and Gynecology 

100 Meadow Road 

Buffalo, New York 14216 



U.S. NAVY MEDICAL NEWS LETTER 



29 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA, MARYLAND 20014 

OFFICIAL BUSINESS 
PERMIT NO. 1048 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



U.S. NAVY MEDICAL NEWS LETTER